PPH Flashcards
what are the criteria for a PPH?
500ml blood loss NVD
1000ml at caesarean
10% decrease in haematocrit; changes in obs
types of PPH
first 24h - primary
24h-12wk - secondary
what are the things to consider in determining cause of PPH?
4 Ts: Tone Trauma Tissue Thrombin
uterine atony + PPH - what happens + what are the causes?
slow + steady blood loss as myometrium doesn’t contract. causes:
uterine distension++ - twins, macrosomia, multiparity
muscles fatigue
sepsis
unable to empty bladder so pushes on uterus
meds eg anaesthetics, mgso2, nifedipine, terbutaline
management of uterine atony PPH
fundal massage urination/catheterisation nipple latch IV oxytocin +- IM carboprost surgery
trauma PPH - what else can happen? how managed?
haematoma - severe pain, persistent bleeding despite contracted uterus
immediate repair - pressure + sticth
tissue PPH - what happens + how managed?
retained placenta (eg if fails to separate in stage 3) prevents contraction + causes uterine atony
causes:
placenta accreta - invades myometrium
traction on cord - caesarean a RF
management:
prevent happening - ensure placenta all out, do VE to check + examine placenta externally
thrombin PPH - what happens + how managed?
coagulopathy in preeclampsia
VWD
placental abruption
can cause DIC
treatment specific to cause
general management of PPH
Inform obs + anaesthetist + activate PPH pathway
A - fundal massage + catheterise
B - 15L hi flow O2 via face mask
C - check bleeding sites, 2x large bore cannulas + fluids; FBC, G+S, clotting +- blood products
D - disability=not contracting so IV oxytocin +- IM carboprost
E - extreme - uterine artery ligation, hysterectomy
general acute management of obstetric bleed
2x large bore cannulas FBC, G+S, clotting fluids hi flow O2 check foetal heart
placenta accreta - what is it? RFs? risks?
attachment of placenta to myometrium
doesn’t separate properly in labour so may cause PPH
RFs - p praevia, prev caesarean
secondary PPH - causes
retained placental tissue
endometritis
