PPH

Question 1

What is the management of a primary PPH?

Answer 1

1. Press the staff assist or emergency bell
2. Page obs registrar, anaesthetist registrar, and senior reg
3. If >1000mL or haemodynamically unstable Call the SR and AR to attend
4. assess the cause 4Ts - Tone, Tissue, Trauma, Thrombin
5. Massage atonic fundus and apply pressure to perineal trauma during resuscitation
6. • IV access: 2x 16 gauge cannula
7. CSL (warmed)
8. Take blood for cross match
9. IDC
10. monitor obs continuously
11. keep warm
12. Check the completeness of the placenta and membranes
13. Commence an oxytocin infusion : 40IU in 500mL CSL at 125mL/hr; increase to 250ml/hr if ongoing bleeding
14. Administer Carboprost 250microg INTRAMUSCULARLY
15. If after 15 minutes the uterus remains atonic, administer a second dose of Carboprost 250microg IM
16. Give synto/ ergo IM if not previously given
17. If ongoing bleeding call theatre CAT 1 within 30 mins CAT2 within 60 mins

Question 2

What are the risk factors for PPH?

Answer 2

Age
Anaemia
APH
Asian/Hispanic
C section or previous
Chorioamnionitits 
Epistiotomy 
Fibroids
GA
Grand Multiparity
IOL
Mal presentation
Diabetes
Von Willebrand’s/ coagulopathies
Mismanaged third stage
obesity BMI >35
Over-distended uterus (polyhydramnios, multiple gestation2, macrosomia
oxytocin use in labour
Hx of PPH
Placenta previa
prolongued labour 1st stage >12 hours 2nd stage >3 hours
pyrexia in labour
retained products

Question 3

What is the definition of a primary PPH?

Answer 3

The World Health Organisation (WHO) defines postpartum haemorrhage (PPH) as vaginal bleeding in excess of 500mL after childbirth.

PPH is the leading cause of maternal mortality worldwide, with the majority of morbidity and mortality occurring within 24 hours of childbirth