PPH

Question 1

Major causes of PPH?

Answer 1

1- atonic uterus
2- retained placenta or fragment of placenta
3- trauma - vaginal lacerations cervical and perineal tears ruptured uterus
4- bleeding dur to c section
5- uterine inversion rare

Question 2

What can you do to prevent PPH?

Answer 2

Iron supp during pregancy to protect vs anaemia.
At risk women -aph -grandmulti - previous pph -multi preg -prolonged labour) must deliver in level 1 2 hospital.
Prevent prolonged labour
Active manage 3rd stage
Post partum vital manage

Question 3

How to prepare staff for pph?

Answer 3

Posters in labour wards
Enough iv infusion sets and fluids
Eniugh drugs ans equip
Drills and skills training

Question 4

What to do to stop bleeding?

Placenta delivered

Answer 4

Do first two steps despite cause!!

1- rub up uterus
2- iv infus 20u of oxytocin in 1ltr fluid.
3- empty bladder as it may cause poor uterine contraction
If atonic still give 0.5mg ergometrine IM unless hpt or cardiac issues… In this case give 400-600mcg of misoprostal
4- suture any bleeding tears

Question 5

What to do to stop bleeding?

Placenta Undelivered

Answer 5

Pv- remove if in os
Manual removal under anaesthesia 
Iv oxytocin 20in 1ltr
Antibiotics
Place in high care for recovery

Question 6

In pph what to do immesiately?

Answer 6

Help
Dont leave pt
2 large iv + fluids

Question 7

What to do in persitant bleeding?

Answer 7

1- review initial dx of bleeding. Suspect coagulopathy secondary to massive hge
2- cross match extra blood or order fresh frozen plasma

Theatre
Additional uterotonic drugs for uterine contraction - ergometrine…
Suture tears
Uterine tamponade with rusch catheter
Examine cavity under anaethesia
Laparotomy - uterine comoression b lynch or uterine artery ligation

Question 8

What happens if they cannot arrest bleeding in theatre?

Answer 8

Emergency hystorectomy

Question 9

What amount of blood loss as a result of NVD or C-Section is PPH?

Answer 9

NVD >500mls

Csection >1000mls