PPH Flashcards
Classification of PPH following:
Vaginal delivery
Caesarean section
> 500ml
>1000ml
minor PPH
major PPH
500-1000ml
> 1000ml
primary PPH
secondary PPH
within 24 hours
24 hours to 12 weeks
4 causes of primary PPH
1) Tone - uterine atony
2) Tissue - retained POC
3) Thrombin - coagulation disorder
4) Trauma - e.g. perineal tear
12 Risk Factors for PPH
1) Previous PPH
2) Large baby
3) Instrumental delivery
4) Episiotomy
5) Failure to progress in the second stage
6) Prolonged third stage
7) Multiple pregnancy
8) GA
9) Obesity
10) Pre-eclampsia
11) Placenta accreta
12) Retained placenta
4 methods of preventing PPH
1) Treatment of anaemia during pregnancy
2) Active management of the 3rd stage of labour
3) Empty bladder while giving birth
4) Tranexamic acid during c-section for high risk patients
Why does a full bladder increase the risk of PPH?
Prevents effective uterus contraction
2 situations for giving FFP in PPH
When there is known coagulopathy
After giving 4 units of blood
2 non-pharmacological methods of controlling PPH
Bimanual uterine massage
Catheterisation
Medical management of PPH (6)
1) 40 IU of syntocinon in 500ml of fluid
2) ergometrine
3) carboprost
4) misoprostol
5) tranexamic acid
6) oxygen (in all pts)
Contraindications of
- Ergometrine
- Carboprost
- HTN
- Asthma
4 surgical management options for PPH
1) Balloon tamponade
2) B-lynch sutures
3) Uterine artery ligation
4) Hysterectomy
2 causes of secondary PPH
1) Infection
2) RPOC
How is secondary PPH investigated? (2)
TVUSS to check for RPOC
High vaginal swabs to check for infection
2 management options for secondary PPH
1) Surgical evacuation (if there are RPOC)
2) Antibiotics (if there is infection)
