PPH Flashcards
Name the two types of PPH and what they mean
Primary PPH - Occurs within 24 hours
Secondary PPH - 24 hours - 12 weeks
Define PPH
Blood loss of > 500 ml after a vaginal delivery
>1000ml after c section
Causes of PPH
4 T’S
Tone
Trauma
Tissue (retained placenta)
Thrombin (clotting disorder)
Signs of uterine inversion
- Rise of fundus
- Lengthening of the cord
- Cush of blood
Can be prevented by not pulling on the cord too early during delivery of placenta.
What are the risk factors of PPH?
6 P’s
Prev. PPH
Prev. C Section
Prolonged labour
Pre-Eclampsia
Polyhydramnios
Placenta Previa
Complications of PPH
'’DASH’’
Sheehan Syndrome
Hypovolemic Shock
Amniotic Fluid Embolism
Death
Medical Management of PPH
COMET
Carboprost IM
Oxytocin
Misoprostol PR
Ergometrine IV or IM
Tranexamic acid
Contraindications of Ergometrine
HTN
PET
Contraindications of carboprost
Asthmatics
Surgical Management Options
Intrauterine Balloon Tamponade (bakree)
B Lynch suture
Uterine/internal iliac artery ligation
Hysterectomy
Last to first - ‘‘HUBI’’
Intrapartum RFs for PPH
'’PAELLA’’
Prolonged 3rd stage
Arrest of descent
Episiotomy
Lacerations
Assisted delivery
How to manage uterine atony?
Bimanual uterine massage and compression +/- oxytocin agents
Types of trauma that can cause PPH?
Uterine inversion + rupture
Vaginal + cervical lacerations
Hematoma
Define Placenta accreta, increta and percreta
Accreta = Adherent to myometrium
Increta = Invades myometrium
Percreta = Penetrates the myometrium
What investigations would you do post PPH?
FBC with platelet
Coag studies: PT-INR, aPTT
Fibrinogen level
D-Dimer
What is active management of 3rd stage?
Clinical
Medical
Surgical interventions
What thrombin disorders are important?
Haemophilia A
Thrombocytopenia
HELLP syndrome
Initial clinical management of PPH
Call for help, ABCs, 2 large-bore IV cannula, O2
Catheterise
Bloods: Group and X match, coag, Hb
Consider blood transfusion
How would you prevent PPH?
Treat Anemia prenatally
Avoid routine episiotomy
Active management of the 3rd stage
What is active management of 3rd stage?
Oxytocin is given
Cord clamped and cut within 2 mins
Controlled cord traction
