Postpartum haemorrhage (PPH)

Question 1

Definition of postpartum haemorrhage (PPH)

• Primary
• Secondary

Answer 1

• Primary
  
  • Loss of >500 ml blood from the genital tract within 24 hours of delivery
• Secondary
  
  • Loss of >500 ml blood from the genital tract between 24 hours and 12 weeks post delivery

Question 2

Aetiology of postpartum haemorrhage

Answer 2

4 Ts:

• Tone
  
  • Uterine atony (most common)
• Tissue
  
  • Retained placenta / membranes (prevents efficient uterine contraction)
• Trauma
  
  • Perineal/vaginal tears (commonly following forceps delivery)
  • Caesarean section
• Thrombin
  
  • Coagulopathies

Question 3

Risk factors for postpartum haemorrhage

• Maternal
• Foetal
• Delivery

Answer 3

• Maternal
  
  • APH
  • Placenta praevia
  • Pre-eclampsia / pregnancy induced HTN
  • Nulliparity
  • Previous PPH
  • Bleeding disorders
  • Obesity
• Foetal
  
  • Large baby
  • Multiple pregnancy
• Delivery
  
  • Caesarean
  • Retained placenta
  • Episiotomy
  • Prolonged labour
  • Maternal pyrexia in labour