Postpartum haemorrhage (PPH) Flashcards
What is postpartum haemorrhage
bleeding after delivery of the baby and placenta
Definition of PPH by blood loss
- 500ml after a vaginal delivery
- 1000ml after a caesarean section
Minor PPH blood loss
<1000ml
Major PPH blood loss
> 1000ml
2 categories of major PPH
Moderate PPH
Severe PPH
Moderate PPH blood loss
1000-2000ml
Severe PPH blood loss
> 2000ml
Primary PPH
Bleeding within 24 hours of birth
Secondary PPH
24 hours - 12 weeks after birth
Causes of PPH (4Ts)
Tone - Uterine atony
Trauma - E.g. perineal tear
Tissue - E.g. Retained placenta
Thrombin - E.g. bleeding disorder
What is the most common cause of PPH?
Uterine atony
What is uterine atony
A failure of the uterus to contract after birth, meaning that the blood vessels aren’t clamped, and therefore causing blood loss
Risk factors for PPH
- Previous PPH
- Multiple pregnancy
- Obesity
- Large baby
- Failure to progress in the second stage of labour
- Prolonged third stage
- Pre-eclampsia
- Placenta accreta
- Retained placenta
- Instrumental delivery
- General anaesthesia
- Episiotomy or perineal tear
Preventative management of PPH
Treat anaemia
Give birth with empty bladder
Active management of 3rd stage (IM oxytocin)
IV tranexamic acid during C-section in high risk
Management to stabilise the patient in PPH
- Resuscitation with an ABCDE approach
- Lie the woman flat, keep her warm and communicate with her and the partner
- Insert two large-bore cannulas
- Bloods for FBC, U&E and clotting screen
- Group and cross match 4 units
- Warmed IV fluid and blood resuscitation as required
- Oxygen (regardless of saturations)
- Fresh frozen plasma is used where there are clotting abnormalities or after 4 units of blood transfusion
- Major haemorrhage protocol
What are the 3 ways in which bleeding can be stopped in PPH
Mechanical
Medical
Surgical
Mechanical management of PPH
Rubbing the uterus to stimulate contraction
Catheterisation
Medical management of PPH
Oxytocin
Ergometrine (Uterine contraction stimulator)
Carboprost (prostaglandin analogue)
Misoprostol (Prostaglandin anologue)
Tranexamic acid
Surgical management of PPH
Intrauterine balloon tamponade
B-lynch suture (Around uterus)
Uterine artery ligation
Hysterectomy
Investigation of secondary PPH
USS for retained products of conception (POC)
Endocervical and high vaginal swabs for infection
