PpH Flashcards
Define PPH
PPH is defined as bleeding of 500ml or more within 24 hours of delivery, or any amount of bleeding that can make a woman feel unwell. Major PPH can be further classified as moderate (100ml-2000ml) or severe (2500ml or more) within the same time frame. frame (Mavrides et al 2016). PPH occurs within the first 24 hours after giving birth, while secondary PPH is any abnormal bleeding that occurs from 24 hours after delivery until 6 weeks later. Secondary PPH is more likely to be caused by retained products of conception or infection, such as endometritis.
What is PPH Epidemiology
The MBRRACE report has revealed that Postpartum PPH is the primary cause of maternal death and morbidity in both low-income and high-income countries, although the incidence of PPH is improving in the UK, with around 1% to 6% incidence. The risk of PPH is higher for women of ethnic minorities, particularly Black women, as highlighted in the Knight et al study conducted in 2023.
Describe PPH pathophysiology
During pregnancy, the volume of maternal blood increases significantly, by almost 50%, from 4 litres to 6 litres. The plasma volume increases by 50%, which is much more than the red blood cell (RBC) volume that increases only by 18%. These changes lead to hemodilution in pregnancy. However, they are necessary to provide a reserve for blood loss after delivery and to meet the perfusion requirements of the low resistance uteroplacental unit. During childbirth, myometrial fibres tighten and narrow the blood arteries as the placenta separates from the uterine wall, decreasing blood loss from this low-resistance vasculature. This process is termed living ligatures or physiologic sutures.
What are the four cause of PPH
There are four causes of PPH uterus atony happens due to tone this may result from inadequate myometrial contraction, which can be caused by retained products of conception tissue. Check that the placenta and membranes are complete doing a vaginal examination. Trauma happens due to perineal laceration; vaginal examination should be performed to identify any signs of genital tract bleeding. The woman should be stabilised, have the laceration repaired, and thrombin due to bleeding disorder. Observe the woman’s blood loss to determine if it is clotting with a blood tests.
What is PPH presentation
PPH can manifest in slow and less noticeable bleeding leading to severe blood loss and shock. Midwives should monitor the women’s vital signs, blood loss, and uterine tone. PPH’s most common symptom is heavy vaginal bleeding that can lead to hypovolemic shock. PPH is a potential life-threatening emergency that demands prompt and appropriate action from the Midwife. The report emphasises on effective communication and teamwork in the management of these cases (14). PPH must be diagnosed and treated quickly to prevent severe hypovolemia.
Define PPH risk factors
Certain factors have been identified as increasing the risk of developing PPH. These risk factors include multiple pregnancies, previous PPH, pre-eclampsia, fetal macrosomia, failure to progress during labour, prolonged third stage of labour, retained placenta, placenta accreta, episiotomy, perineal laceration, and general anaesthesia. Control case studies have helped identify these risk factors.
PPH preventive measure
According to the NICE guideline, pregnant women should be given the option to undergo screening for anaemia. A recent population-based study has discovered a connection between antenatal anaemia (Hb levels below 90 g/l) and increased blood loss during delivery and postpartum. Treating anaemia during the antenatal period may reduce the risk associated with PPH.
What is PPH management
Studies have demonstrated that two approaches, active management and preventive uterotonics, can reduce the risk of PPH happening during the third stage of labour. The active management third stage of labour involves the administration of uterotonics drugs, promptly clamping the cord, and using controlled cord traction to deliver the placenta. These techniques are designed to facilitate the expulsion of the placenta and reduce blood loss.
What is oxytocin and ergometrine critical point
McDonald et al. 2004 did a meta-analysis that looked at how well oxytocin alone or ergometrine-oxytocin together prevented PPH of more than 1000 ml during the third stage of birth. The review discovered that oxytocin 5 iu, oxytocin 10 iu, and ergometrine-oxytocin all worked equally in Preventing PPH of more than 1000 ml. Ergometrine and oxytocin have been used in clinical practice for a long time, but there has not been any study directly comparing them as first-line treatments for PPH. Both drugs should be used, but oxytocin should be used first, especially in women who have high blood pressure or pre-eclampsia.
What is TXA critical point
TXA reduces bleeding by slowing blood clot breakdown. TXA has been used as an additional treatment for PPH even though it is not licensed for obstetric use. The 2017 WOMAN Trial found that giving TXA to women with PPH within three hours of giving birth reduces bleeding-related death as well as the need for surgery to control bleeding by 33.3%. The trial involved almost 20,000 women from throughout the world and had no negative effects on either mothers or babies (Brenner et al., 2019). TXA use should be implemented as a standard policy in obstetrics.
What is the benefit of bi-mechanical compression
A study was conducted in Ghana to examine the impact of team-based bimanual uterine compression for managing PPH from uterine atony. Results suggest that bimanual uterine compression is more effective when performed by a team. Although bimanual compression is effective, it causes significant discomfort to the woman and is a tiring maneuver for one person to maintain, Individuals were unable to fully compress the uterus and maintain compression for more than 150 seconds.
What is PPH prevention management
PPH is an obstetric emergency and needs to be managed by an experienced team, including senior midwives, obstetricians, anaesthetics, haematologists, blood bank staff and porters. At call home 999 and in hospital pull the emergency buzzer once help arrive instruct someone to call 2222 stating obstetric emergency PPH
Step 1
Get help: call for help SOAPS,rub up contractions, catheter insertion, bimanual compression and treat underlying issues.
Head: lie the woman flat, ABC management oxygen regardless of saturation, take observation every 5 mins communicate with women and partner.
Step 2
Person 1: insert canula, take blood FBC,Clotting screening ,U&E’s,Group and cross match 4 units, prepare O neg blood, warmed IV fluid crystalloid/colloid.
Person 2: Ergometrine/Syntometrine 5iu/500mcg syntocinon infusion 10iu, TXA 1g slow IV ,Carboprost 250mcg, Misoprostol 800mcg per rectum.
What are alternative PPH management options
There are several procedures that can be used to manage PPH if physical and pharmacological treatments are unsuccessful in controlling severe blood loss, then balloon tamponade, haemostatic brace suturing, selective artery embolisation, or a hysterectomy may be considered (RCOG,2016).
