Postpartum haemorrhage Flashcards
PPH definition
Blood loss of >500ml after a vaginal delivery
Primary PPH
Within 24 hours
Secondary PPH
Between 24 hours and 6 weeks
Typically due to retained placental tissue or endometritis
Causes of PPH
Tone (uterine atony)- vast majority
Trauma (perineal tear)
Tissue (retained placenta)
Thrombin (clotting/ bleeding disorder)
Risk factors
Previous PPH
Prolonged labour
Pre-eclampsia
Increased maternal age
Polyhydramnios
Emergency C section
Placenta praevia/ accreta
Macrosomia
Management
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
Surgery
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
Classification of blood loss
Minor <1000ml
Major (moderate) 1000-2000ml
Major (severe) >2000ml