PPH Flashcards
What is a primary postpartum haemorrhage?
Blood loss of >500ml within the first 24 hours of birth.
What is a secondary postpartum haemorrhage?
Blood loss of >500mls after the first 24 hours of birth up until 6 weeks postpartum.
What dose of IM/IV syntocinion do you administer in a PPH?
10 IU IM into the outer middle thigh or 5 IU IV.
What actions should you take in early recognition of a PPH?
- Lie the woman flat (gravity)
- Baby skin to skin (stimulate oxytocin)
- Fundal massage (expel clots)
- Administer 10 IU IM syntocinon (contract uterus)
- Observations (TPR, BP, EBL)
- Empty bladder
What are the four T’s for causes of PPH?
Tone, Tissue, Trauma, Thrombin
What is tone referring to in a PPH?
Uterine atony (failure of the uterus to contract sufficiently)
- 70% of PPH causes
What is tissue referring to in a PPH?
- Retained placenta (not birthed within expected timeframe)
- Membranes not complete/intact = fragments remain inside)
- Placenta accreta (placenta grows too deeply into uterine wall)
- 10% of PPH causes
What is trauma referring to in PPH?
- Lacerations to the uterus (C-section)
- Episiotomy
- 20% of PPH causes
What is thrombin referring to in PPH?
- Excessive bleeding due to inadequate blood clotting (anticoagulation)
- <1% PPH cause
In early recognition of PPH, how would you minimise the impact of blood loss?
- Call obstetrician
- Insert large bore IV cannulation
- Start rapid IV fluids with crystalloids (sodium chloride 0.9%)
- Take blood for FBC, G+H, Coagulation
What actions will you take for ongoing bleeding in PPH?
- Administer syntometrine 1ml IM (no more than 3ml in 24hrs)
- Bimanual compression (stop bleeding)
- Oxytocin infusion 40 IU in 500ml sodium chloride 0.9% over 4 hours
- Ask senior obstetrician and midwifery team to attend immediately
- Insert indwelling catheter (empty bladder to prevent it from stopping the uterus from contracting)
