PPH Flashcards

1
Q

What does post partum haemorrhage refer to?

A

-bleeding after delivery of baby and placenta

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2
Q

How much blood must be lost to be classified as PPH?

A
  • 500ml after vaginal delivery

- 1000ml after c section

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3
Q

What can PPH be classified into?

A
  • minor PPH - <1000ml
  • major PPH -> 1000ml (subclassified into moderate PPH 1000-2000ml and sever >2000ml)
  • primary PPH: within 24hrs of birth
  • secondary PPH: from 24hrs to 12 weeks after birth
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4
Q

What are the causes of PPH?

A

4 Ts:

  • Tone (uterine atony -most common cause)
  • Trauma (e.g perineal tear_
  • Tissue (retained placenta)
  • Thrombin (bleeding disorder)
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5
Q

What are some RFs for PPH?

A
  • previous PPH
  • multiple pregnancy
  • obesity
  • large baby
  • failure to progress in 2nd stage
  • prolonged third stage
  • pre-eclampsia
  • placenta accreta
  • retained placenta
  • instrumental delivery
  • general anaesthesia
  • episiotomy or perineal tear
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6
Q

What measures can be done to reduce risk of PPH?

A
  • treat anaemia during antenatal period
  • give birth with empty bladder (as full bladder reduces uterine contraction)
  • active management of 3rd stage
  • IV tranexamic acid can be used during C section in high-risk pts
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7
Q

What does management of PPH involve?

A

is an obstetric emergency:

  • resus with ABCDE approach
  • lie woman flat, keep her warm and communicate with her and 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 resus as required
  • oxygen (regardless of sats)
  • fresh clotting abnormalities or after 4 units of blood transfusion
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8
Q

What can the treatment options to stop the bleeding in PPH be split into?

A
  • mechanical
  • medical
  • surgical
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9
Q

What do mechanical treatment options involve in PPH?

A
  • rubbing the uterus (fundus) to stimulate uterus contraction
  • catheterisation (bladder distention prevents uterine contraction)
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10
Q

What do medical treatment options involve in PPH?

A
  • oxytocin (slow injection followed by continous infusion)
  • ergometrine (IV or IM) stimulates smooth muscle contraction (contraindicated in hypertension)
  • carboprost (IM) - prostogalandin analogue which stimulates uterine contraction
  • misoprostol (sublingual) also prostaglandin analogue
  • tranexamic acid (IV) - antfibrinolytic so reduced bleeding
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11
Q

What do surgical treatment options involve in PPH?

A
  • Intrauterine balloon tamponade – inserting an inflatable balloon into the uterus to press against the bleeding
  • B-lynch suture - putting a suture around the uterus to compress it
  • uterine artery ligation - stops supply to uterus reducing blood flow
  • hysterectomy as a last resort
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12
Q

What is secondary PPH most likely due to?

A

-retained products of conception (RPOC
or
-infection - endometritis

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13
Q

What are the investigations for secondary PPH?

A
  • US to look for RPOC

- endocervical and high vaginal swabs for infection

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14
Q

What is the management of secondary PPH?

A
  • surgical evaluation of retained products of conception

- antibiotics for infection

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