Postpartum haemorrhage

Question 1

PPH definition

Answer 1

Blood loss of >500ml after a vaginal delivery

Question 2

Primary PPH

Answer 2

Within 24 hours

Question 3

Secondary PPH

Answer 3

Between 24 hours and 6 weeks

Typically due to retained placental tissue or endometritis

Question 4

Causes of PPH

Answer 4

Tone (uterine atony)- vast majority

Trauma (perineal tear)

Tissue (retained placenta)

Thrombin (clotting/ bleeding disorder)

Question 5

Risk factors

Answer 5

Previous PPH

Prolonged labour

Pre-eclampsia

Increased maternal age

Polyhydramnios

Emergency C section

Placenta praevia/ accreta

Macrosomia

Question 6

Management

Answer 6

Immediate senior involvement

A-E approach
- 2 peripheral cannulae
- lie flat
- bloods (including G&S)
- warmed crystalloid infusion

Palpate uterus and catheterise

IV oxytocin, ergometrine, carboprost (unless asthma)

Surgery

Question 7

Surgery

Answer 7

Intrauterine balloon tamponade first line where uterine atony is only or main cause

B-lynch suture, ligation of uterine arteries or internal iliac arteries

Hysterectomy

Question 8

Classification of blood loss

Answer 8

Minor <1000ml

Major (moderate) 1000-2000ml

Major (severe) >2000ml