Postpartum Haemorrhage Flashcards
what is postpartum haemorrhage?
blood loss of >500ml after a vaginal delivery and may be primary or secondary
what is the definition of a primary postpartum haemorrhage?
occurs within 24 hours
what are the causes of a primary postpartum haemorrhage?
Tone (uterine atony)
Trauma (e.g. perineal tear)
Tissue (retained placenta)
Thrombin (e.g. clotting/bleeding disorder)
what are the risk factors for primary postpartum haemorrhage?
- previous PPH
- prolonged labour
- pre-eclampsia
- increased maternal age
- polyhydraminos
- emergency C-section
- placenta praevia, placenta accreta
- macrosomia
what fluids should be given to a women with a primary postpartum haemorrhage?
warmed crystalloid infusion
what is the mechanical management of primary postpartum haemorrhage?
- palpate the uterine fundus and rub it to stimulate contractions
- catheterisation to prevent bladder distension and monitor urine output
what is the medical management of primary postpartum haemorrhage?
- IV oxytocin = IV injection –> infusion
- ergometrine slow IV or IM
- carboprost IM
- misoprostol usblingual
- tranexamic acid
when can you not give ergometrine in primary postpartum haemorrhage?
history of hypertension
when can you not give carboprost in primary postpartum haemorrhage?
history of asthma
what is the first-line medical management of primary postpartum haemorrhage?
- 5U of IV syntocinon (oxytocin)
- 0.5mg of ergometrine
what is the surgical management of primary postpartum haemorrhage?
- uterine atony = intrauterine balloon tamponade
- b-lynch suture
- ligation of the uterine arteries or internal iliac arteries
what surgical procedure is done in a life-threatening primary postpartum haemorrhage?
hysterectomy
what is the definition of a secondary postpartum haemorrhage?
occurs between 24 hours - 6 weeks
what are the causes of a secondary postpartum haemorrhage?
- retained placental tissue
- endometritis
