PostPartum Problems Flashcards
What is the average loss of blood after labour?
300ml
How does the body stop alot of blood loss after labour?
SM contraction
Woman in hypercoagulable state
Define PPH
Vaginal bleeding >500ml
What is 1’ PPH
From delivery the baby up to 24hr later
What is 2’ PPH
Within 6 weeks of delivery
What is uterine inversion and why does it happen?
When uterus starts to come out of pelvis/detaches from wall
Midwife pulls uterus out too much after delivery in attempt to deliver placenta
What are the 4 types of 1’PPH
Tone/Atony
Trauma
Tissue
Thrombin
What % of primary PPH are due to atony?
90%
Risk factors atonic PPH (9)
Multiple pregnancy Grand multiparity Polyhydramnios Fibroid uterus Prolonged labour, induced labour Previous PPH APH Big baby Oesophageal atresia
Treatment atonic PPH
Misoprostol Cintametrine Bakri balloon Uterine aa occlusion Hysterectomy (last resort)
What is a 1’ tear?
Tear of perineal skin
What is a 2’ tear?
Tear into perineal mm
What is a 3’ tear?
Tears through anal sphincter –> loss of bowel fct
What is a 4’ tear?
Tears into anal sphincter + rectum
Causes of PPH tears
Big babies
Malposition
Forceps delivery
Long labour
Tx PPH tears
Repair in delivery under LA
What is a succenturirate lobe?
extra lobe of placenta that can sometimes cause a PPH
Secondary causes of PPH
Lochia
Infection e.g. endometriosis
Retained product - placenta
Tx 2’ PPH
AB
Empty out womb
How to examine a Pt w/ 1’PPH
A-E AMount of blood lost Urine output Uterine contraction Fundal height Placenta + membranes complete Genital tract trauma
How to examine a pt w// 2’PPH
Basic obs
h fundus
Speculum
Bimanual - size uterus
What would tachyC, pyrexia and uterine tenderness indicate?
Endometriosis
Investigations of 1’PPH
Bloods - clotting, placelets, haem, G+S + cross match
U/E if urine output poor
Investigations of 2’PPH
FBC - WCC to excl infection
USS
How to calculate maternal mortality ratio
Maternal mortality ratio = no’ deaths /100,000 maternities (births after 24 weeks of gestation)
What % of women w/ puerperal psychosis have a pre-existing psych Hx
30%
By having a CSC, how much does your risk of getting placenta acreta increase?
40%
4 drugs to give to a woman haemorrhaging after pregnancy
Oxytocin
Ergometrine
Haemovate
Misoprostol
