PPH

Question 1

criteria for PPH

Answer 1

with vaginal bleeding in excess of 500 ml within 24 hours of birth.

Question 2

what to do if the placenta has not been delivered

Answer 2

LMC is not available, seek urgent clinical advice regarding controlled cord traction to help deliver the placenta.

Question 3

most common cause of PPH

Answer 3

uterine atony and/or a retained placenta.

Question 4

what is secondary PPH

Answer 4

occurs between 24 hours and six weeks after delivery.

Question 5

should oxytocin be administered in secondary PPH

Answer 5

yes

Question 6

if a recently pregnant patient has signs of shock, it is by definition severe, why?

Answer 6

Pregnant women have an expanded blood volume and can lose more than one litre of blood without showing signs of shock

Question 7

what is an amniotic fluid embolism?

Answer 7

a rare presentation: Amniotic fluid embolism occurs when amniotic fluid enters the maternal circulation, causing a severe inflammatory response that has a high mortality rate.

Question 8

presentation of an amniotic fluid embolism

Answer 8

Signs and symptoms include tachypnoea, hypoxia and shock.
If shock is disproportionate to blood loss and unresponsive to IV fluid resuscitation, amniotic fluid embolism should be considered a possibility and adrenaline IV (preferably by infusion) should be administered.

Question 9

Management of PPH

Answer 9

Pressure on compressible bleeding
Feel for uterus and massage firmly
Begin transport
Seek help from an LMC
10 units oxytocin IM
IV access
1 g TXA IV
Seek urgent advice if placenta not delivered

Question 10

what to do if the patient is showing signs of shock

Answer 10

ICP backup plus fluids

Question 11

management if the shock is severe and the patient is deteriorating post management

Answer 11

bimanual compression + ICP for adrenaline