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Obs & Gynae > Postpartum haemorrhage > Flashcards

Postpartum haemorrhage Flashcards

1
Q

What is primary postpartum haemorrhage?

A

Greater than >500ml of blood loss in the first 24 hours

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2
Q

What would be considered a moderate amount of blood loss in primary postpartum haemorrhage?

A

1000ml-2000ml

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3
Q

What would be considered a severe amount of blood loss in primary postpartum haemorrhage?

A

> 2000ml

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4
Q

What is secondary postpartum haemorrhage?

A

Abnormal bleeding that occurs from 24 hours - 12 weeks after delivery

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5
Q

What property of blood in postpartum haemorrhage should be looked for?

A

Clotting

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6
Q

What are the causes of primary postpartum haemorrhage? (4Ts)

A

Tone - the tone of the uterus itself
Trauma - lacerations in vagina/uterus
Tissue - retained products i.e. placenta
Thrombin - Coagulopathy

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7
Q

What is the most common cause of postpartum haemorrhage?

A

Uterine atony

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8
Q

What is uterine atony?

A

Oxytocin levels are increased during delivery, causing contractions of the uterus, and these compress the myometrial blood vessels, preventing haemorrhage
If there are no contractions, there is no compression of the blood vessels and haemorrhage occurs

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9
Q

What is the key risk factor for uterine atony?

A

Multiple gestation

Uterus is stressed so much that contractions fail to compress vessels adequately

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10
Q

What are the risk factors for placental retention?

A

Structural abnormality e.g. placenta accreta, percreta and increta

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11
Q

What is one of the key signs of trauma as the cause of postpartum haemorrhage?

A

Shock disproportionate to blood loss

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12
Q

How can postpartum haemorrhage due to coaogulopathy be prevented?

A

Check clotting factors, Hb, INR etc at antenatal screening

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13
Q

What other antenatal factors can increase risk of postpartum haemorrhage?

A 
Previous caesarean section
Placenta praevia, percreta, accreta
Pre-eclampsia
Previous PPH or retained placenta
Multiple pregnancy
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14
Q

What active management in the third stage of labour can prevent postpartum haemorrhage?

A

Syntocinon given just after delivery of anterior shoulder

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15
Q

What intrapartum factors increase risk of postpartum haemorrhage?

A 
Prolonged labour (particularly in nulliparous women)
Mediolateral episiotomy
Arrest of descent
Lacerations
Augmented labour
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16
Q

How should a lady with mild postpartum haemorrhage but no signs of shock be managed?

A

Close monitoring

Start fluids

17
Q

How should a lady with postpartum haemorrhage >1000mls and/or signs of shock be managed?

A 
Resuscitate: call for help & ABCDE
Lie patient flat
Uterine massage 
5 units IV syntocinon
40 units Syntocinon in 500ml hartmanns - 125 ml/h
18
Q

Who should be called and in what order for help in obstetric emergency?

A

Senior midwife, senior obstetrician, anaesthetist, haematologist, blood transfusion lab, porter, someone to note everything down

19
Q

How can postpartum haemorrage due to tone be managed?

A 
Uterine massage/bimanual compression
Ergometrine
Synctocinon
Carboprost
Misoprostol
20
Q

What surgical management can be given for postpartum haemorrhage?

A 
Undersuturing
Brace Sutures
Uterine Artery Ligation
Internal Iliac Artery Ligation
Hysterectomy
21
Q

What is uterine inversion?

A

A complication of childbirth that occurs when the placenta fails to detach from the uterus as it exits, pulls on the inside surface, and turns the organ inside out

22
Q

What might uterine inversion look like on examination?

A

Looks like mass protruding from vagina

23
Q

How does uterine rupture present?

A

Shock disproportionate to bleeding
Loss of contractions
Obstructed labour
Peritonism

24
Q

What changes on CTG might be seen in uterine rupture?

A

Fetal bradycardia or intrauterine death

25
Q

What is the main risk factor for uterine rupture?

A

Previous cesarean sections

26
Q

How can placental retention be managed?

A

Brandt manoeuvers
Injection of syntocinon in umbilical vein
Manual removal of placenta

27
Q

What is the main cause of secondary postpartum haemorrhage?

A

Endometritis

28
Q

What usually causes endometritis?

A

Retained placental products

29
Q

How is endometritis investigated?

A

Bloods
Swabs
Ultrasound

30
Q

How is endometritis treated?

A

Amoxicillin and metronidazole

Obs & Gynae (20 decks)

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