PPH

Question 1

Definition of PPH

Answer 1

Current thinking defines PPH as:
Minor (500-1000mls)
Major (more than 1000mls)
Severe (more than 2000mls)

RCOG, 2016

Question 2

How can PPH be classified?

Answer 2

Primary - within 24 hours

Secondary - between 24 hours and 6 weeks

Question 3

What is the incidence of PPH?

Answer 3

5-10% of all deliveries

Question 4

Main guidelines for PPH?

Answer 4

RCOG, 2016

Question 5

What is a likely cause of secondary PPH?

Answer 5

Trickle of blood. Can be caused by retained products. Need to consider sepsis, infection, uterine involution.

Question 6

What do RCOG 2016 recommend to reducing PPH

Answer 6

Active management of third stage
Oxytocin
Multi-professional management

Question 7

What are CMACE recommendations?

Answer 7

All staff should regular training on identification and management of maternal collapse and hidden bleeding
Using early warning system to help recognition
Severe haemorrhage - need senior colleagues
How to care for women who refuse blood products
Management of placenta percreta
Women to be advised that CS are not entirely risk free
All women with previous section should have placenta site determined

Question 8

What is the lowest Hb going into labour?

Answer 8

8.5

Question 9

PPH risk factors in history?

Answer 9

Previous PPH
grand multip
Primip
Obesity 
Asian ethnicity

Question 10

PPH risk factors antenatally?

Answer 10

Maternal hb below 8.5gd/l
BMI >35
APH 
platelets <100
Overdistension of uterus 
Abnormal placenta location
Fibroids >5cm
Maternal age >35

Question 11

PPH risk factors - intrapartum

Answer 11

Prolonged 1st, 2nd, 3rd stage 
IOL
oxytocin 
Episiotomy 
Lacerations 
CS, Instrumental
Shoulder dystocia 
Precipitate labour/delivery (rapid)

Question 12

What are NICE, 2014 recommendations to prevent PPH?

Answer 12

Women with PPH should be advised to give birth in obstetric led unit
Risks of PPH should be highlighted in notes and care plan including 3rd stage should be done.
Unit should have strategies in place to respond quickly and appropriately

Question 13

Potential complications of PPH

Answer 13

Severe anaemia 
Pituitary infarction - pituitary gland deprived of blood and oxygen. Sheehan’s syndrome. 
Coagulopathies
Renal damage -lack of perfusion. 
Coma 
Death

Question 14

Preventing PPH

Answer 14

Treat anaemia antenatally
Avoid routine episiotomy
Actively manage 3rd stage (MBRACE)
Close observation post delivery

Question 15

What do the 4 T’s stand for in causes of PPH?

Answer 15

Tone
Trauma
Tissue
Thrombin