Postpartum Haemorrhage PPH Flashcards
What is postpartum haemorrhage (PPH)?
PPH is defined as blood loss of ≥500 ml after vaginal delivery or ≥1000 ml after caesarean section within 24 hours of delivery.
What are the two types of PPH?
Primary PPH occurs within 24 hours of delivery, and secondary PPH occurs between 24 hours and 6 weeks postpartum.
What are the most common causes of primary PPH?
Causes include uterine atony (most common), retained placental tissue, trauma to the genital tract, and coagulopathy.
What is the mnemonic for the causes of PPH?
The “4 Ts” mnemonic: Tone (uterine atony), Tissue (retained placenta), Trauma (genital tract tears), Thrombin (coagulopathy).
What is uterine atony, and why does it cause PPH?
Uterine atony is the failure of the uterus to contract effectively after delivery, leading to uncontrolled bleeding from placental vessels.
What are the risk factors for PPH?
Risk factors include prolonged labour, multiple pregnancy, polyhydramnios, macrosomia, induction of labour, and uterine overdistension.
How is PPH diagnosed?
Diagnosis is clinical, based on visible blood loss, haemodynamic instability, or symptoms such as dizziness or pallor.
What are the signs of PPH on clinical examination?
Signs include visible blood loss, uterine atony on palpation, tachycardia, hypotension, and pallor.
What is the initial management of PPH?
Initial management involves calling for help, resuscitation with fluids or blood products, and identifying the cause of bleeding.
What first-line drugs are used to manage uterine atony?
Uterotonic agents such as oxytocin, ergometrine, and misoprostol are first-line treatments.
What surgical interventions are available for PPH?
Surgical options include uterine balloon tamponade, B-Lynch sutures, uterine artery ligation, or hysterectomy in severe cases.
What is the role of tranexamic acid in PPH?
Tranexamic acid reduces bleeding by inhibiting fibrinolysis and is used in conjunction with other treatments.
How is genital tract trauma managed in PPH?
Trauma is managed by identifying and repairing tears, using sutures for lacerations or surgical intervention for significant injuries.
What investigations are important in PPH?
Investigations include full blood count (FBC), coagulation profile, crossmatch for blood, and bedside clotting tests if needed.
What is secondary PPH, and what are its common causes?
Secondary PPH refers to bleeding 24 hours to 6 weeks postpartum, commonly caused by retained products of conception or infection.
How is secondary PPH managed?
Management includes antibiotics for infection, evacuation of retained products, and addressing any underlying causes of bleeding.
What are the complications of PPH?
Complications include hypovolaemic shock, disseminated intravascular coagulation (DIC), organ failure, and maternal death.
How is blood loss estimated during PPH?
Blood loss is estimated visually or using calibrated collection devices, though underestimation is common with visual methods.
What are the risk factors for uterine atony?
Risk factors include overdistended uterus, prolonged labour, chorioamnionitis, and use of tocolytics during labour.
What steps can be taken to prevent PPH?
Prevention includes active management of the third stage of labour with uterotonics and early identification of risk factors.
What is the importance of active management of the third stage of labour in PPH prevention?
Active management reduces the risk of PPH by promoting uterine contraction and preventing uterine atony.
What are the components of active management of the third stage of labour?
Components include administration of a uterotonic, controlled cord traction, and uterine massage.
What is a B-Lynch suture, and when is it used?
A B-Lynch suture is a surgical technique used to compress the uterus and control bleeding in cases of severe uterine atony.
How is disseminated intravascular coagulation (DIC) managed in PPH?
DIC is managed with blood products (e.g., fresh frozen plasma, platelets) and treatment of the underlying cause of bleeding.
How can PPH impact future pregnancies?
PPH may increase the risk of anaemia, uterine scarring, and recurrence of PPH in subsequent pregnancies.
What support should be provided to women after PPH?
Support includes counselling about the event, management of anaemia, and planning for future pregnancies to reduce recurrence risk.
