PPH

Question 1

Definition

Answer 1

500ml or more of blood within the first 24 hours of delivery

Question 2

Causes: 4Ts

Answer 2

1. Tone

The most common cause of PPH is uterine atony, which is the failure of the uterus to contract after delivery.

2. Trauma

PPH may come from a birth canal injury or tear. This risk is increased in instrumented deliveries.

3. Tissue

Retained placental or foetal tissue can lead to continued bleeding

4. Thrombin

Coagulopathies can lead to continued bleeding due to a failure of clotting.

Question 3

RFs

Answer 3

PPH in previous pregnancy

BMI >35

Multiple pregnancy

Parity >4

Placenta praevia or accreta

Placental abruption

Pre-eclampsia or gestational hypertension or anaemia

Delivery via Caesarean section

Induction of labour

Instrumented delivery (forceps or ventouse) and episiotomy

Prolonged labour (greater than 12 hours)

Macrosomia (>4kg baby)

Advanced maternal age