PPH

Question 1

what is it?

Answer 1

Postpartum haemorrhage (PPH) is defined as blood loss of > 500 ml after a vaginal delivery and may be primary or secondary.

Question 2

when does primary PPH occur?

Answer 2

within 24 hours.

Question 3

what are the causes of primary PPH?

Answer 3

Question 4

what are TF for primary PPH?

Answer 4

previous PPH
prolonged labour
pre-eclampsia
increased maternal age
polyhydramnios
emergency Caesarean section
placenta praevia, placenta accreta
macrosomia

Question 5

what is PPH mx- ABC?

Answer 5

two peripheral cannulae, 14 gauge
lie the woman flat
bloods including group and save
commence warmed crystalloid infusion

Question 6

what is PPH mx - mechanical?

Answer 6

palpate the uterine fundus and rub it to stimulate contractions (‘rubbing up the fundus’)
catheterisation to prevent bladder distension and monitor urine output

Question 7

what is PPH mx - medical?

Answer 7

IV oxytocin: slow IV injection followed by an IV infusion
ergometrine slow IV or IM (unless there is a history of hypertension)
carboprost IM (unless there is a history of asthma)
misoprostol sublingual
there is also interest in the role tranexamic acid may play in PPH

Question 8

what is PPH mx - surgical?

Answer 8

intrauterine balloon tamponade
B-Lynch suture, ligation of the uterine arteries or internal iliac arteries
if severe, uncontrolled haemorrhage then a hysterectomy is sometimes performed as a life-saving procedure

Question 9

what is the order of PPH mx?

Answer 9

ABC approach
mehcanical
medical
surgical

Question 10

what is secondary PPH?

Answer 10

Secondary PPH occurs between 24 hours - 12 weeks. It is typically due to retained placental tissue or endometritis.