Postpartum Haemorrhage

Question 1

What is a postpartum haemorrhage defined as?

Answer 1

Blood loss from the genital tract following delivery of the baby of 500mls or any loss that is detrimental to the womans’ condition

Question 2

What is the difference between primary and secondary pph?

Answer 2

Primary: first 24 hours
Secondary: 24 hours - 6 weeks

Question 3

What are the 4 causes of a PPH?

Answer 3

Tone
Trauma
Tissue
Thrombin

Question 4

What are predisposing factors for a PPH?

Answer 4

• Full bladder
• Long labour
• Multiple pregnancy
• Previous pph
• APH
• Instrumental
• Retained placenta
• Mismanaged third stage
• Fibroids

Question 5

What is the initial management of a PPH?

Answer 5

• Recognise problem
• Buzzer - obstetric emergency - state PPH - communication with woman - lie flat - move the baby to safety - give high-flow oxygen.
• Massage the uterus continuously to help contract
• Obtain IV access (2x large bore cannulae + bloods FBC, X match 4 units, group and save and clotting)
• Fluid replacement (IV)
• Observations: temp, pulse, oxygen saturations, blood pressure
• Assess cause (4 t’s) - if trauma repair
• Stop the bleeding with uterotonics
• Empty bladder and insert catheter for accurate hourly urine output
• Bi manual compression
• Consider blood transfusion
• Move to theatre, balloon tamponade, hysterectomy, central line

Question 6

What uterotonic drugs are administered for a post partum haemorrhage?

Answer 6

Syntocinon 10 units (for active 3rd stage - works within 2-4 mins)
Syntometrine ??????

Tranexamic acid: 1g given slow IV injection - can be repeated in 30 mins time if pph continues
Carboprost: 250mcg every 15 minutes for 8 doses (given IM)
Misoprostol: 800mcg given PR
Syntocinon infusion: 40 unit synto IV over 4 hours

Question 7

Postnatal care post PPH…

Answer 7

Assess EBL
Consider blood transfusion
Postnatal observations 
Closely monitor woman’s condition
Accurate fluid balance
Debrief with woman, personally and MDT