PPH Flashcards
What is the classification of PPH in NORMAL delivery?
500ml +
What is the classification of PPH in C Section?
1000ml +
What are the different severity classifications of PPH? (3 things)
- Minor PPH: Under 1000ml
- Major PPH: 1000-2000ml
- Severe PPH: 2000ml +
What is the different TIMING classifications of PPH? (2 things)
- Primary PPH: Within 24 hours of birth
- Secondary PPH: from 24 hours – 12 wks after birth
What are the causes of PPH? (4 things)
- Tone (uterine atony aka no tone) (most common cause)
- Trauma
- Tissue (retained placenta)
- Thrombin
(4 T’s)
How does Uterine atony cause PPH?
Lack of tone in uterine muscle –> uterus can’t contract properly
What are the types of Trauma that cause PPH?
Vaginal / Cervical / Perineal tears
What are the RF for Trauma causing PPH? (3 things)
- Instrumental delivery
- Episiotomy
- C section
How does a retained placenta cause PPH?
Stops uterus from contracting
What does Thrombin refer to as a cause of PPH? (2 things)
- Vascular abn
- Coagulopathies
What Vascular abn cause PPH? (3 things)
- Placental abruption
- HTN
- Pre-eclampsia
What Coagulopathies cause PPH? (3 things)
- von Willebrand’s disease
- Haemophilia A/B
- DIC
What are the RF for PPH? (12 things)
- PPH Hx
- GA
- Obesity
- Multiple pregnancy
- Large baby
- Failure to progress to 2nd stage of labour
- Prolonged 3rd stage
- Pre-eclampsia
- Placenta accreta (grows into uterus wall)
- Retained placenta
- Episiotomy / perineal tear
- Instrumental delivery
Apart from the obv bleeding, what other CF can you get if substantial PPH? (4 things)
- Dizziness
- Palpitations
- SOB
- Haemodynamic instability
What might you see @ Abd examination of PPH?
Signs of uterine rupture (aka fetal parts as it moves from uterus –> abd)
What might you see @ Speculum examination of PPH?
Local trauma sites may be revealed
What should you examine after PPH? Why?
- Placenta
- To ensure placenta is incomplete
What causes of PPH might you see @ Placenta examination? (2 things)
- Missing cotyledon
- Ragged membranes
What is the pneumonic for the Mx plan for PPH?
TRIM
What does TRIM stand for as the Mx plan of PPH? (4 things)
- Teamwork (Immediate)
- Resus (ABCDE) (Immediate)
- Investigations + Monitoring (Immediate)
- Measures to arrest bleeding (Definitive)
Who is involved in the Teamwork aspect of PPH Mx? (6 things)
- Obstetricians
- Anaesthetists
- Haematologist
- Midwife in charge + Midwives
- Blood bank
- Porters
What Investigations should you for PPH? (5 things)
- FBC
- Cross match 4-6 units blood
- Coag profile
- UnEs
- LFT
How should you Monitor a PPH? (5 things)
- RR
- O2 sats
- HR
- BP
- Temperature
How often should you do the Monitoring things for PPH?
Every 15 mins
What else should you consider for Monitoring PPH? (2 things)
- Catheterisation
- Central venous line insertion
What are the Definitive Mx option titles for PPH? (3 things)
- Mechanical
- Medical
- Surgical
What are the MECHANICAL Mx options for PPH?
- Rubbing uterus (thru abd)
- Catheterization
How does Rubbing uterus work to manage PPH?
Stimulates uterine contraction
How does Catheterization work to manage PPH?
Reduces bladder distention
(which was preventing uterine contractions)
What are the MEDICAL Mx options for PPH? (5 things)
- Oxytocin
- Ergometrine (IV / IM)
- Carboprost (IM)
- Misoprostol (subling)
- Tranexamic acid (IV)
How should Oxytocin be administered in PPH Mx?
Slow injection then continuous infusion
How does Ergometrine work in PPH Mx?
Stimulates SMC contractions
When is Ergometrine CI for PPH Hx?
HTN
What class of meds are Carboprost + Misoprostol?
Prostaglandin analogue
How do Carboprost + Misoprostol work in PPH Mx?
Stimulate uterine contraction
What class of meds is Tranexamic acid?
Antifibrinolytic
How does Tranexamic acid work in PPH Mx?
Reduces bleeding
What are the SURGICAL Mx options for PPH? (4 things)
- IU balloon tamponade
- B-Lynch suture
- Uterine artery ligation
- Hysterectomy (last resort)
How does IU balloon tamponade work in PPH Mx?
Insert inflatable balloon into uterus to press against bleeding
How does B-Lynch suture work in PPH Mx?
Putting suture around uterus to compress it
How does Uterine artery ligation work in PPH Mx?
Ligate 1+ arteries supplying uterus to reduce blood flow
How does Hysterectomy (last resort) work in PPH Mx?
Stops bleeding + saves woman’s life
What are the causes of Secondary PPH (24 hrs – 12 wks)? (2 things)
- Retained products of conception (RPOC)
- Inf (e.g endometritis)
What investigations should you do for Secondary PPH? (2 things)
- US (for RPOC)
- Endocervical + high vaginal swabs (for inf)
What are the Mx options for Secondary PPH? (2 things)
- Surgery (for RPOC)
- Abx (for inf)
How do you prevent PPH even happening in 1st place? (4 things)
- Treat anaemia during antenatal period
- Give birth on empty bladder
- Active Mx of 3rd stage (w IM oxytocin)
- IV Tranexamic acid in C section for high risk pt
