Postpartum haemorrhage

Question 1

causes of primary post partum haemorrhage ?

Answer 1

retained tissue
uterine atony
coagulopathy
perineal tears

Question 2

describe the categories of 1st - 4th degree perineal tears.

Answer 2

1st degree - superficial
2nd degree - tear through the perineal muscles
3rd degree - tear through the perineal muscles and anal sphincter
4th degree - tear through the perineal muscles, anal sphincter and rectum

Question 3

primary vs secondary PPH ?

Answer 3

primary > 500ml blood loss within 24 hours of delivery

secondary > 500ml blood loss between 24 hours to 12 weeks post delivery

Question 4

causes of secondary PPH ?

Answer 4

endometritis

retained placental tissue

Question 5

describe the pharmacological management of PPH ?

Answer 5

1st line: synocinon 5U IV slow injection

2nd line: ergometrine 500mg i/m

3rd line: syntocinon infusion

4th line: carbaprost i/m

5th line: misoprostol 1000mcg rectal

6th line: surgery

Question 6

contraindications to ergometrine ?

Answer 6

hypertension

pre-eclampsia

Question 7

surgical management options for PPH ?

Answer 7

vessel ligation 
BAKRI balloon tamponade 
brace suture 
hysterectomy 
radiological arterial embolisation

Question 8

initial management of PPH ?

Answer 8

call for help 
ABCDE 
check for;
- retained placenta
- tears in genital tract 
- uterine tone 
02
further IV access
fluid replacement
bloods;
- FBC, U&E, LFT's
- clotting, group and save 
- lactate 

massaging contractions
bimanual compression of the uterus