Postpartum Haemorrhage

Question 1

What is it?

Answer 1

> 500ml blood loss following vaginal delivery
1L following C section

Question 2

What is Primary PPH?

Answer 2

Haemorrhage occurring within 24 hours of delivery

Causes
-Tone
- Thrombin
- Trauma
- Tissue

Question 3

What are risk factors for primary PPH?

Answer 3

Previous PPH
Prolonged labour
PET
Increased maternal age
Polyhydraminos
Emergency C section
Placental praevia or accreta
Macrosomia

Question 4

What is the management of primary PPH?

Answer 4

A- E assessment
Mechanical
- massage uterus to stimulate contraction

Medical
- IV oxytocin to improve uterine contraction
- IV ergometrine- stimulates uterine contraction (cannot have in HTN)
- IM carboprost- stimulate uterine contraction (not in asthma)

Surgical
- IU balloon tamponade
- Hysterectomy

Question 5

What is secondary PPH and what are the causes?

Answer 5

Bleeding occurring from 24 hours to 12 weeks post delivery

Causes
- Infection- endometritis- foul smelling discharge, bleeding, pyrexia
- retained products

Treat with abx for infection or surgical removal of products

Question 6

What is placenta accreta?

Answer 6

Implantation of placenta into myometrium causing problems of separating the placenta during delivery

Risk factors
- prev C section/ increasing maternal age

Question 7

How is placenta accreta diagnosed and managed?

Answer 7

Diagnosed during TVUS during pregnancy
Treat with planned C section and steroids with uterus preserving surgery or hysterectomy