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Reproductive - Childbirth > Postpartum Haemorrhage > Flashcards

Postpartum Haemorrhage Flashcards

1
Q

What defines PPH?

A

Blood loss 500ml+ after delivery of the baby

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2
Q

What is primary PPH?

A

PPH within 24 hours of delivery

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3
Q

What is secondary PPH?

A

PPH between 24 hours and 6 weeks after delivery

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4
Q

What defines a minor PPH?

A

Blood loss of 500-1000ml without clinical shock

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5
Q

What defines a major PPH?

A

Blood loss > 1l or signs of CV collapse/ongoing bleeding

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6
Q

What are the 4 causes of PPH from most to least common?

A

Tone, trauma, tissue, thrombin

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7
Q

What is meant by ‘tone’ as a cause of PPH?

A

There is uterine atony - a lack of uterine contractility

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8
Q

What is meant by ‘trauma’ as a cause of PPH?

A

Perineal tears or surgical trauma

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9
Q

What is meant by ‘tissue’ as a cause of PPH?

A

Retained placental tissue

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10
Q

What is meant by ‘thrombin’ as a cause of PPH?

A

Clotting factor deficiency, either primary or secondary to massive blood loss and DIC

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11
Q

What are the main ways of preventing PPH?

A

Identifying antenatal and intrapartum risk factors early, and active management of the 3rd stage of labour

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12
Q

What are some antenatal risk factors for PPH?

A

Previous PPH, placental problem, previous C-section, large for dates pregnancy

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13
Q

If a patient who is a Jehovah’s witness has risk factors for PPH, what should you do?

A

Plan an advance directive

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14
Q

What are the intrapartum risk factors for PPH?

A

Prolonged labour, operative vaginal delivery, C-section, retained placenta

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15
Q

Explain what happens in active management of the third stage of labour?

A

10 units oxytocin alone (syntocinon) or 5 units of oxytocin with 500mcg of ergometrine (syntometrine) is given

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16
Q

Which method of active management of the third stage of labour is preferred and why? What is the disadvantage to this?

A

Syntometrine as it causes a sustained, tonic contraction. It causes hypertension.

17
Q

What is the presentation of PPH if > 1l?

A

Maternal collapse

18
Q

What is the presentation of PPH if < 1l?

A

Hypovolaemic shock - hypotension, tachycardia, tachpnoea

19
Q

How do you identify the aetiology of PPH?

A

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

20
Q

What is the first thing to do when a patient has PPH and why?

A

Get help - this requires simultaneous management

21
Q

What are the aims of management for PPH?

A

Promptly treat the underlying cause while administering adequate resuscitation with fluids and blood products

22
Q

You should be careful prescribing fluids in who?

A

Women with pre-eclampsia

23
Q

How should fluid replacement be done in PPH?

A

IV crystalloid (Hartmann’s/0.9% saline) should be given to treat hypovolaemia while awaiting blood products

24
Q

Which blood products should be given if a woman with PPH is showing signs of DIC?

A

FFP, cryoprecipitate and platelets

25
Q

How often should maternal observations be done when there is PPH?

A

Every 15 minutes

26
Q

What is the specific management for PPH caused by atony?

A

‘Rub up’ the uterus to stimulate a contraction, oxytocic drugs

27
Q

What is the specific management of PPH caused by trauma?

A

Repair trauma under regional anaesthesia

28
Q

What is the specific management of PPH caused by retained products?

A

Evacuate the products in theatre

29
Q

What is the specific management of PPH caused by a clotting deficiency?

A

Blood products

30
Q

What are the causes of secondary PPH?

A

Retained products of conception or endometritis

31
Q

How should you investigate secondary PPH?

A

US

32
Q

What are some last line management options for PPH?

A

Haemostatic balloon in the uterine cavity and uterine compression sutures have a tamponade effect / hysterectomy

33
Q

What are the post-event management options for PPH?

A

Thromboprophylaxis, manage anaemia, debrief couple, consider risk management

Reproductive - Childbirth (9 decks)

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