PPH

Question 1

Signs of placenta separation

Answer 1

Lengthening of the cord

Show of blood

Question 2

Why not deliver placenta before it’s separated?

Answer 2

Might invert uterus

Vaso vagal shock, hypotension, maternal death

Question 3

Oxytocics available?

Answer 3

Syntocinon 10 units IV
Ergometrine 0.25mg IV
Syntometrine IM

Question 4

How long placenta delivered ‘naturally’?

Answer 4

An hour

Question 5

Why active management of 3rd stage?

Answer 5

Reduce PPH

Question 6

Technique to active management

Answer 6

Controlled cord traction

Question 7

Do you press on uterus after syntocinon?

Answer 7

Nope. Let it be, watch for cord lengthening

Question 8

Primary PPH?

Answer 8

Within 24 hours more than 500ml

Question 9

Secondary PPH?

Answer 9

After 24 hours Up to 6 weeks, excessive amount of loss

Question 10

Commonest cause of PPH?

Answer 10

Uterine atony (70%)

Question 11

Why must uterus contract in 3rd stage

Answer 11

Controlled PPH via uterine muscle contraction

Question 12

Causes Uterine atony?

Answer 12

Polyhydramnios
Multiple pregnancy
Macrosomia
Mass - fibroids
PROLONGED LABOUR

Question 13

Causes of PPH via trauma 20%

Answer 13

episiotomy, tear in perineum
Vaginal tear
Cervical tear
Uterine rupture

Question 14

Uterine rupture tends not to occur in?

Answer 14

Primigravid

Question 15

PPH other causes

Answer 15

retained products

Coagolopathy

Question 16

Coagulopathies around the time of delivery? 1% of time.

Answer 16

Preeclampsia
Eclampsia
DIC
Placenta abruption
Amniotic fluid embolism

Question 17

% of PPH

Answer 17

70% uterine atony
20% - trauma
9% - retained products
1% - coagulapathy

Question 18

Pre delivery causes of coagulopathies

Answer 18

Von willebrands

Throbocytopaenia

Question 19

How much blood loss you need before transfusion?

Answer 19

1500 mL, EVEN if pulse and BP is ok.

Question 20

If PPH and bleeding, given syntocinon, still bleeding what to do?

Answer 20

Give ergometrine
Rub the uterus
Look for tears - usu. venous pressure
Take bloods for coags

Question 21

Don’t forget to put in what to help uterine contraction?

Answer 21

Urinary catheter to empty the bladder

Question 22

If lose 1500mL, then what?

Answer 22

Give transfusion
Take her to theatre!!
-check for inversion, rupture, products
PGF2alpha

Question 23

If after surgical exploration after losing 1500mL and still not control?

Answer 23

• Balloon catheter 500mL for 24 hr. ABx.
• Ligation of the uterine arteries/internal iliac arteries
• laparotomy, hysterectomy for survival

Question 24

If someone has preeclampsia, how to manage PPH?

Answer 24

Try to avoid ergometrine

Question 25

If PPH from coag disorder, how to manage?

Answer 25

Balloon catheter

Then give coags, FFP, platelets

Question 26

Causes of secondary PPH

Answer 26

Infection

Retained products

Question 27

secondary PPH Management?

Answer 27

FBE, CRP

ABx

Question 28

Signs of secondary PPH Infection?

Answer 28

Febrile

Tender uterus

Question 29

secondary PPH Speculum?

Answer 29

Look for discharge
Cervix likely to be open
TAKE SWABS

Question 30

ABx for secondary PPH?

Answer 30

Penicillin
Metronidozole
If over 39 degrees: Gentamicin
All IV

Question 31

secondary PPH For retained products management?

Answer 31

U/S

Hysteroscopy D&C

Question 32

Risk of using sharp curette for retained products?

Answer 32

Ashermann’s syndrome

Question 33

Risk of VBAC for uterine rupture?

Answer 33

1 in 200

Question 34

Risk of VBAC of uterine rupture with augmentation?

Answer 34

1 in 100, up to 1 in 25

Question 35

If not delivered placenta by 1 hour what to do?

Answer 35

Take them to theatre for manual removal