PPH

Question 1

What are the four T’s of PPH?

Answer 1

TONE
TISSUE
TRAUMA
THROMBIN

Question 2

What uterotonics are used for management of PPH?

Answer 2

Ergometrine
Misoprostal
Carboprost
Transemic acid TXA

Question 3

Ergometrine - what is the dose and how is it given?

Answer 3

250mg IV and 250mg IM simultaneously

Question 4

What are the causes of a PPH due to TONE?

Answer 4

Partial separation of the placenta
Retained products
Prolonged labour >12hrs
Precipate labour <3hrs
Placenta previa or placental abruption
Induction/augmentation
Full bladder
Overextended uterine muscle
Mismanaged third stage

Question 5

What are the causes of a PPH due to TISSUE?

Answer 5

Retained placenta – check the placenta and membranes are complete following 3rd stage

Question 6

What are the causes of a PPH due to TRAUMA?

Answer 6

+ Perineum damage
+ Episiotomy

Question 7

What are the cause of a PPH due to THROMBIN?

Answer 7

Coagulation disorders

Question 8

What are the risk factors for PPH?

Answer 8

• Hx of PPH or retained placenta
• Shoulder dystocia
• Obstetric interventions – induction, forceps and vacuum delivery, episiotomy
• Presence of fibroids
• Parity >6
• Maternal anaemia
• Multiple pregnancy
• HIV/AIDs
• Caesarean section
• Drug induced hypotonia – MgS04, Pines, salbutamol
• Intrapartum haemorrhage

Question 9

What complementary medication should be given with Ergometrine and why?

Answer 9

Ondansetron for nausea and vomiting

Question 10

Carboprost - what is the dose and how is it given?

Answer 10

250mcg Deep IM injection

Question 11

What complementary medication should be given with Carboprost and why?

Answer 11

GastroSTOP for the side effect of diarrhoea

Question 12

How often and what is the total amount of doses of Ergometrine given?

Answer 12

Every 15 minutes - given twice in room before going to theatre

Question 13

How often and what is the total amount of doses of Carboprost given?

Answer 13

Every 5 minutes

Question 14

TXA - what is the dose and how is it given?

Answer 14

1000mcg in 100mls - IV

Question 15

Misoprostol - what is the dose and how is it given?

Answer 15

1000mcg 5 tablets - given PR

Question 16

What is 40 units of Syntocinon used for?

Answer 16

Maintenance

Question 17

How to treat PPH? Run through what tasks need to be checked off

Answer 17

(Baby born)
- 10 units of syntocinon

(Placenta born)
- check placenta –TISSUE–

(Perineum check)
- check perineum –TRAUMA–

(Treat Hypovolaemia)
- Fluids NaCl
- IVC x 2
- Obs every 5 mins
- Bloods –THROMBIN–
- Weigh blood loss 1g=1ml

(–TONE–)
- rub fundus
- Medications (ergometrine, carboprost, misoprostal, TXA, syntocinon)

(Debrief and document)

Question 18

What is involved in the follow-up of a PPH?

Answer 18

• FBC
• Consider blood transfusion or iron transfusion
• Clotting profile
• IV antis
• Debriefing
• Documentation