postpartum haemorrhage

Question 1

definition of postpartum haemorrhage

Answer 1

blood loss > 500ml after vaginal delivery
may be primary or secondary

Question 2

causes of primary postpartum haemorrhage

Answer 2

4Ts
Tone: uterine atony (majority)
Trauma: perineal tear
Tissue: retained placenta
Thrombin: clotting/bleeding disorder

Question 3

risk factors for PPH

Answer 3

previous PPH
prolonged labour
pre-eclampsia
increased maternal age
polyhydramnios
emergency c-section
placenta praevia, placenta accreta
macrosomia

Question 4

management of PPH

Answer 4

ABC approach: 14g cannula, lie women flat, group and save, warmed crystalloid infusion

mechanical: palpate the uterine fundus and rub it to stimulate contractions, catheterise

medical:
- IV oxytocin
- ergometrine
- carboprost IM (asthma contraindicated)
- misoprostol sublingual

surgical: if medical options fail
- intrauterine balloon tamponade first line for uterine atony
- b-lynch suture, ligation of uterine arteries or internal iliac arteries
- hysterectomy