Postpartum Haemorrhage

Question 1

The first cause of maternal mortality is PPH and it accounts for —- of maternal death

Answer 1

25-50%

Question 2

Risk factors for PPH

Answer 2

Previous history of PPH
●APH
●Fetal demise
●Hypertensive Disorders of Pregnancy
●Uterine overdistension
●Bleeding disorders
●High parity
●Obesity

Question 3

Causes of PPH and aetiology

Answer 3

-Tone -uterine atony
Causes: Fibroid uterus, placenta previa, APH , uterine overdistention, tocolytics , mismanagement of third stage of labor
- Trauma: vulvovaginal injury, episiotomy, uterine rupture
-Tissue: obstructed labor, prolonged third stage of labor, placenta abnormalities
- Thrombin: placenta abruptio, sepsis: IUD, PROM, massive blood loss, massive blood transfusion, hepatitis

Question 4

Physiological changes in pregnancy causes increase in blood volume by

Answer 4

30-60% which averages 1-2L

Question 5

Prevention of PPH

Answer 5

-Detection and treatment of anemia during antenatal period
-Early detection and management of prolonged labour
-Cautious use of oxytocic agents in labour
-Active management of third stage of labor

Question 6

Advantages of uterine artery embolization

Answer 6

Preserves fertility
Useful in haemorrhage associated with placenta previa

Question 7

Disadvantages of uterine artery embolization

Answer 7

Patient must be stable
Requires 24hr availability of radiological expertise

Question 8

Morbidity and mortality from PPH

Answer 8

Thromboembolism
Shock and DIC
Renal failure
Puerperal sepsis
Lactation failure
Blood transfusion reaction