PPH Flashcards
what is primary PPH
loss of >500ml in first 24h after delivery (1L in C section)
causes primary
uterine atony, genital tract trauma, clotting disorders
risk factors
prev PPH or retained placenta, APH, BMI >35, anaemic, multiparity 4+, maternal age >35, uterine malformation/fibroid, large placental site, low placenta, prolonged labour, induction/oxytocin use, C section
what needs to happen to restrict blood flow through uterine vessels
uterine contraction- shortens uterine vessels, retracts placental bed. if doesn’t contract then haemorrhage
what may happen after placenta delivery leading to a rising fundus
blood may clot inside the uterus and not be expelled
management primary
oxytocin 5mu IV. O2. bloods
causes of PPH the 4 Ts
Tone, Trauma, Tissue (retained products), Thrombin (coag)
who should you alert in PPH
minor- midwife, obs and anaethestics, major- consultants blood transfusion
what is third stage bleeding
placenta still in uterus
management 3rd stage bleeding
contraction rubbed up, fundal pressure with cord traction try and deliver placenta. if cant be delivered- uterine exploration.
what is a true PPH
placenta has been expelled
management true PPH
massage uterus, Hartmanns, ergometrine IV or syntocinon (oxytocin), syntometrine , misoprostol
if PPH is severe what can you give
carboprost- directly into myometrium or deep IM
what is contraindicated in hypertension
syntometrine
when is transfusion needed
if >1000ml
if bleeding continues with the treatment what can you give
oxytocin 10units in 500ml dextrose
further steps in PPH after medical treatment
bimanual pressure, tranexamic acid, explore uterus for rupture.
surgical treatments PPH
hysterectomy, uterine packing, vessel ligation (internal iliac or uterine ). B lynch brace uterine suture
use of what drug in 3rd stage labour reduces rates primary PPH
oxytocin
what is secondary PPH
excessive blood loss from the genital tract after 24h from delivery (usually 5-12 days)
what is secondary PPH due to
retained placental tissue or clot. endometritis
what can occur in secondary PPH
infection
when is exploration necessary in secondary PPH
heavies blood loss, retained product in US, tender uterus, open os
management secondary PPH
cross match blood. pre op antibios. curette the uterus
