Postpartum Haemorrhage Flashcards
What defines PPH?
Blood loss 500ml+ after delivery of the baby
What is primary PPH?
PPH within 24 hours of delivery
What is secondary PPH?
PPH between 24 hours and 6 weeks after delivery
What defines a minor PPH?
Blood loss of 500-1000ml without clinical shock
What defines a major PPH?
Blood loss > 1l or signs of CV collapse/ongoing bleeding
What are the 4 causes of PPH from most to least common?
Tone, trauma, tissue, thrombin
What is meant by ‘tone’ as a cause of PPH?
There is uterine atony - a lack of uterine contractility
What is meant by ‘trauma’ as a cause of PPH?
Perineal tears or surgical trauma
What is meant by ‘tissue’ as a cause of PPH?
Retained placental tissue
What is meant by ‘thrombin’ as a cause of PPH?
Clotting factor deficiency, either primary or secondary to massive blood loss and DIC
What are the main ways of preventing PPH?
Identifying antenatal and intrapartum risk factors early, and active management of the 3rd stage of labour
What are some antenatal risk factors for PPH?
Previous PPH, placental problem, previous C-section, large for dates pregnancy
If a patient who is a Jehovah’s witness has risk factors for PPH, what should you do?
Plan an advance directive
What are the intrapartum risk factors for PPH?
Prolonged labour, operative vaginal delivery, C-section, retained placenta
Explain what happens in active management of the third stage of labour?
10 units oxytocin alone (syntocinon) or 5 units of oxytocin with 500mcg of ergometrine (syntometrine) is given
Which method of active management of the third stage of labour is preferred and why? What is the disadvantage to this?
Syntometrine as it causes a sustained, tonic contraction. It causes hypertension.
What is the presentation of PPH if > 1l?
Maternal collapse
What is the presentation of PPH if < 1l?
Hypovolaemic shock - hypotension, tachycardia, tachpnoea
How do you identify the aetiology of PPH?
Abdominal palpation to ‘rub up’ a uterine contraction is carried out while the placenta and membranes are checked for completeness and the cervix/vagina/perineum are checked for lacerations
What is the first thing to do when a patient has PPH and why?
Get help - this requires simultaneous management
What are the aims of management for PPH?
Promptly treat the underlying cause while administering adequate resuscitation with fluids and blood products
You should be careful prescribing fluids in who?
Women with pre-eclampsia
How should fluid replacement be done in PPH?
IV crystalloid (Hartmann’s/0.9% saline) should be given to treat hypovolaemia while awaiting blood products
Which blood products should be given if a woman with PPH is showing signs of DIC?
FFP, cryoprecipitate and platelets
How often should maternal observations be done when there is PPH?
Every 15 minutes
What is the specific management for PPH caused by atony?
‘Rub up’ the uterus to stimulate a contraction, oxytocic drugs
What is the specific management of PPH caused by trauma?
Repair trauma under regional anaesthesia
What is the specific management of PPH caused by retained products?
Evacuate the products in theatre
What is the specific management of PPH caused by a clotting deficiency?
Blood products
What are the causes of secondary PPH?
Retained products of conception or endometritis
How should you investigate secondary PPH?
US
What are some last line management options for PPH?
Haemostatic balloon in the uterine cavity and uterine compression sutures have a tamponade effect / hysterectomy
What are the post-event management options for PPH?
Thromboprophylaxis, manage anaemia, debrief couple, consider risk management
