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Obstetric Emergencies > Postpartum Haemorrhage > Flashcards

Postpartum Haemorrhage Flashcards

1
Q

How much blood loss defines Postpartum Haemorrhage?

A

500mls or more

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2
Q

How much blood loss defines Minor Postpartum Haemorrhage?

A

500mls-1000mls

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3
Q

How much blood loss defines Moderate Postpartum Haemorrhage?

A

1001mls-2000mls

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4
Q

How much blood loss defines Severe Postpartum Haemorrhage?

A

> 2000mls

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5
Q

What is primary PPH?

A

Occurs in the first 24 hours after birth, most common

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6
Q

Most common PPH?

A

Primary

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7
Q

What is secondary PPH?

A

Occurs between 24 hours after birth to the end of puerperium (6 weeks)

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8
Q

Maternal morbidity and mortality from PPH is caused by?

A

hypovolemia

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9
Q

What is hypovolemia?

A

decrease in cardiac output and blood pressure from a decrease in cardiac return

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10
Q

What are the consequences of hypovolemia?

A

impairs tissue oxygenation and may lead to -
. renal/hepatic organ failture
. acute respiratory distress syndrome (ARDS)
. Sheehan’s syndrome
. disseminated intravascular coagulation (DIC)

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11
Q

What are the 2 risk factor groups for primary PPH?

A

anetnatal and intrapartum

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12
Q

What are the antenatal risk factors for PPH?(9)

A

1, placental abruption

  1. placenta previa
  2. multiple pregnancy
  3. pre-eclampsia
  4. gestational hypertension
  5. previous PPH
  6. Obesity (BMI >35)
  7. Anaemia (<90 g/l)
  8. age (>40 years, primip)
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13
Q

What are the intrapartum risk factors for PPH?(9)

A
  1. caesarean section
  2. induction of labour
  3. retained placenta
  4. mediolateral episiotomy
  5. instrumental birth
  6. prolonged labour (>12 hours)
  7. macrosomia (>4kg)
  8. pyrexia in labour
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14
Q

What are the 4 T’s - causes of PPH? In order

A
  1. uterine TONE abnormalities
  2. retained pregnancy TISSUE
  3. genital tract TRAUMA
  4. THROMBIN (coagulation defects)
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15
Q

What do the abnormalities of uterine contraction (TONE) include?

A
  1. over distended uterus from
  2. uterine muscle exhaustion
  3. intra-amniotic infection
  4. drug induced uterine hypotonia
  5. functional or anatomic distortion of the uterus
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16
Q

what can cause over distended uterus?

A
  • polyhydramnios
  • multiple pregnancy
  • macrosomia
17
Q

What can cause uterine muscle exhaustion?

A

rapid or incoordinate labour

  • prolonged labour (1st, 2nd or 3rd stage)
  • labour dystocia
  • high parity
  • oxytocin for induction or augmentation of labour
18
Q

What can cause intra-amniotic infection?

A
  • pyrexia

- prolonged rupture membranes (>24 hours)

19
Q

what can cause drug induced uterine hypotonia?

A
  • Mag. sulphate, nifedipine, salbutamol

- general anaesthesia

20
Q

what can cause functional or anatomic distortion of the uterus?

A
  • fibroid uterus
  • uterine anomalies
  • APH
21
Q

What does Trauma include?

A
  • episiotomy or lacerations
  • extensions/lacerations at caesarean section
  • uterine rupture
  • uterine inversion
22
Q

what is included in retained pregnancy Tissue?

A
  1. retained products
    - membranes
    - blood clots
    - cotyledon/succenturiate lobe
  2. abnormal placenta
    - placenta accreta/increata/pancreata
23
Q

What does coagulopathy (Thrombin) include?

A
  1. therapeutic anti-coagulation
  2. coagulation disorders
  3. thrombocytopenia associated with pre-eclampsia
  4. disseminated intravascular coagulation (DIC)
  5. Retained intrauterine fetal death
  6. severe infection
  7. amniotic fluid embolism
24
Q

what are 6 PPH preventative measures?

A
  1. TREATING antenatal anaemia
  2. ACTIVE MANAGEMENT of 3rd stage
  3. CHECKING for and repairing genital trauma early
  4. CONFIRMING placenta and membranes are complete
  5. OBSERVING any blood loss for clotting
  6. REGULAR OBSERVATIONS to detect early signs of compromise
25
Q

What does active management of 3rd stage include?

A
  • oxytocin administration
  • controlled cord traction
  • cord clamping between 1 and 5 minutes of birth
26
Q 
What are:
- symptoms 
- degree of shock
- systolic pressure
- pulse
- respiratory rate
after 1 minute of blood loss?
A
  • palpitations but includes dizziness
  • compensated
  • 91-140mmHg (normal)
  • normal
  • 14-20
27
Q 
What are:
- symptoms 
- degree of shock
- systolic pressure
- pulse
- respiratory rate
after 2 minute of blood loss?
A
  • weakness and sweating
  • mild
  • 80-100mmHg
  • > 100bpm
  • 20-30
28
Q 
What are:
- symptoms 
- degree of shock
- systolic pressure
- pulse
- respiratory rate
after 3 minute of blood loss?
A
  • restless, pallor, oliguria
  • moderate
  • 70-80mmHg
  • > 120bpm
  • 30-40
29
Q 
What are:
- symptoms 
- degree of shock
- systolic pressure
- pulse
- respiratory rate
after 4 minute of blood loss?
A
  • collapse, air hunger, anuria
  • severe
  • 50-70mmHg
  • > 140bpm
  • > 35
30
Q

All women respond differently to blood loss. Clinical findings will vary depending on the womans…? (3)

A
  1. haemoglobin prior to blood loss
  2. stature and body mass
  3. rate and volume of blood loss
31
Q

Order of steps when dealing with PPH?

A
  1. Initial assessment and treatment
  2. treat the cause
  3. if bleeding doesn’t stop
  4. intractable bleeding
32
Q

What does initial assessment and treatment include?

A
  • resuscitate
  • assess aetiology and arrest blood loss
  • blood tests
33
Q

When you call for help in a PPH situation, who should be in the room to effectively manage this obstetric emergency?

A
  1. Senior midwife
  2. Experienced obstetrician
  3. Experienced anaesthetist
  4. Additional support staff
  5. Alert haematologist and blood bank
  6. Porter
  7. Theatre staff to be on stand by
34
Q

how can you stop bleeding?

A
  • rub up a contraction/massage uterus
  • administer first line drug therapy
  • catheterise the bladder
  • repair any tears

Obstetric Emergencies (9 decks)

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