PPH Flashcards
What is a primary PPH?
Primary PPH: loss of > 500ml blood from the genital tract within 24 hours after vaginal delivery. Or 1000ml at C-section.
What is a secondary PPH?
Secondary PPH: excessive bleeding (500mls or more) from the genital tract between 24 hours and 12 weeks postpartum
Major haemorrhage?
over 1500ml
10% blood loss?
compensated - normal BP, tacky, palps, dizzy\
15% blood loss?
mild - Hypotension systolic 90-80 mmHg
Tachycardia, tachypnoea
30% blood loss?
moderate - Hypotension 80-60R, >100 bpm,
Restlessness
40% blood loss?
severe -hypotension <50mmHg, Confusion or unconsciousness, collapse
Causes of PPH?
Tone - uterine atony
Tissue - clots, AIP
Trauma - tearing
Thrombin - coagulopathies
Risk factors?
prev PPH, multiple gestation, polyhram, PROM, placenta, operative deliveries, APH
2 large cannulas and take?
FBC, G X match 4 units, clotting, fibrinogen
How much Hartmans should we give?
Up to 1.5L
How would we manage a PPH pharmacologically?
active 3rd stage
Syntometrine 1amp Oxytocin 10IU
Ergometrine 1amp
2nd Syntometrine
Oxytocin infusion - 30 IU running at 160ml/hr
TXA 1 g (100mg/ml) slow IV 1ml/min
Carboprost 250 mcg given IM every 15 min max (up to 8 doses)
Misoprostol 800mcg-1000mcg PR
What else can be used to treat atony?
bimanual uterine compression
What should be done in PPH (tissue)
empty bladder, CCT, check placenta, MROP
What should be done in PPH (trauma)
check for a suture tears
