PPH

Question 1

what is primary PPH

Answer 1

loss of >500ml in first 24h after delivery (1L in C section)

Question 2

causes primary

Answer 2

uterine atony, genital tract trauma, clotting disorders

Question 3

risk factors

Answer 3

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

Question 4

what needs to happen to restrict blood flow through uterine vessels

Answer 4

uterine contraction- shortens uterine vessels, retracts placental bed. if doesn’t contract then haemorrhage

Question 5

what may happen after placenta delivery leading to a rising fundus

Answer 5

blood may clot inside the uterus and not be expelled

Question 6

management primary

Answer 6

oxytocin 5mu IV. O2. bloods

Question 7

causes of PPH the 4 Ts

Answer 7

Tone, Trauma, Tissue (retained products), Thrombin (coag)

Question 8

who should you alert in PPH

Answer 8

minor- midwife, obs and anaethestics, major- consultants blood transfusion

Question 9

what is third stage bleeding

Answer 9

placenta still in uterus

Question 10

management 3rd stage bleeding

Answer 10

contraction rubbed up, fundal pressure with cord traction try and deliver placenta. if cant be delivered- uterine exploration.

Question 11

what is a true PPH

Answer 11

placenta has been expelled

Question 12

management true PPH

Answer 12

massage uterus, Hartmanns, ergometrine IV or syntocinon (oxytocin), syntometrine , misoprostol

Question 13

if PPH is severe what can you give

Answer 13

carboprost- directly into myometrium or deep IM

Question 14

what is contraindicated in hypertension

Answer 14

syntometrine

Question 15

when is transfusion needed

Answer 15

if >1000ml

Question 16

if bleeding continues with the treatment what can you give

Answer 16

oxytocin 10units in 500ml dextrose

Question 17

further steps in PPH after medical treatment

Answer 17

bimanual pressure, tranexamic acid, explore uterus for rupture.

Question 18

surgical treatments PPH

Answer 18

hysterectomy, uterine packing, vessel ligation (internal iliac or uterine ). B lynch brace uterine suture

Question 19

use of what drug in 3rd stage labour reduces rates primary PPH

Answer 19

oxytocin

Question 20

what is secondary PPH

Answer 20

excessive blood loss from the genital tract after 24h from delivery (usually 5-12 days)

Question 21

what is secondary PPH due to

Answer 21

retained placental tissue or clot. endometritis

Question 22

what can occur in secondary PPH

Answer 22

infection

Question 23

when is exploration necessary in secondary PPH

Answer 23

heavies blood loss, retained product in US, tender uterus, open os

Question 24

management secondary PPH

Answer 24

cross match blood. pre op antibios. curette the uterus