Postpartum haemorrhage Flashcards
What is postpartum haemorrhage (PPH)?
PPH is defined as blood loss of > 500 ml after a vaginal delivery and may be primary or secondary.
When does primary postpartum haemorrhage occur?
Primary PPH occurs within 24 hours.
What percentage of deliveries are affected by primary PPH?
Primary PPH affects around 5-7% of deliveries.
What are the 4 Ts that cause primary PPH?
The 4 Ts are: Tone (uterine atony), Trauma (e.g. perineal tear), Tissue (retained placenta), Thrombin (e.g. clotting/bleeding disorder).
What are the risk factors for primary PPH?
Risk factors include previous PPH, prolonged labour, pre-eclampsia, increased maternal age, polyhydramnios, emergency Caesarean section, placenta praevia, placenta accreta, macrosomia, and nulliparity.
What is the management approach for PPH?
PPH is a life-threatening emergency requiring immediate involvement of senior staff, following the ABC approach.
What initial actions should be taken in the management of PPH?
Actions include establishing two peripheral cannulae (14 gauge), lying the woman flat, blood tests including group and save, and commencing warmed crystalloid infusion.
What mechanical management techniques are used for PPH?
Mechanical techniques include palpating and rubbing the uterine fundus and catheterisation to prevent bladder distension and monitor urine output.
What medical treatments are used for PPH?
Medical treatments include IV oxytocin, ergometrine, carboprost, and misoprostol. Tranexamic acid may also play a role.
What surgical options are considered for PPH?
If medical options fail, surgical options include intrauterine balloon tamponade, B-Lynch suture, ligation of uterine arteries, or hysterectomy in severe cases.
When does secondary postpartum haemorrhage occur?
Secondary PPH occurs between 24 hours and 12 weeks.
What are the typical causes of secondary postpartum haemorrhage?
Secondary PPH is typically due to retained placental tissue or endometritis.
