PPH

Question 1

Percentage oxytocin’s reduce risk of PPH

Answer 1

50%

Question 2

Percentage of women that PPH

Answer 2

5-15%

Question 3

Blood flow to placenta at term

Answer 3

750ml/min

Question 4

Mechanism physiological to avoid PPH

Answer 4

Construction of blood vessels supplying the placenta bed by uterine contraction

Question 5

Placental causes of pph

Answer 5

Atony (prolonged lab, inc parity, oxy w/d, uterine overdistension (mult preg, poly, macrosomia), instrumental birth
RPOC
Praevia
Accreta
Inversion
Bleeding disorder
  -thrombocytopenia
  -DIC
   -hereditary bleeding disorders

Question 6

Total blood volume at term

Answer 6

100ml/kg

Ie 50kg-k=5000ml

Question 7

Basic resus

Answer 7

ABC
High flow o2
Wide bore iv access
Bloods - FBC, cows, xmatch
Warmed fluids
O- if needed
MTP
Keep woman warm and flat

Question 8

Ecbolics

Answer 8

Oxytocin 5IU IV
40IU over 4 hours
Ergometrine 0.25mg - can repeat every 5 min up to max 1 min.
Misoprostol up to 1000mcg rectally
15-methyl-PGF2alpha (Carboprost)- 0.25mg q15min up to 2.0mg

Question 9

Other internal causes of bleeding

Answer 9

Ruptured uterus, broad ligament haematoma, subcapsular liver rupture, ruptured spleen, ruptured splenic artery, hepatic artery or pancreatic artery aneurysm

Question 10

Surgical management

Answer 10

Balloon tampon are
B-lynch
Bilateral ligation of uterine arteries
Bilateral ligation of internal iliacs
Arterial embolisation
Hysterectomy

Question 11

Misoprostol in low income settings
Dosage
Benefits

Answer 11

800 sublingual

Safe, effective, easy admin, transient SE, stable at room temp, widely available

Question 12

Measures for minor PPH

Answer 12

IV access 1 x 14G
Bloods
Vitals Q15min
Warmed crystalloid

Question 13

Major pph and continuing to bleed or signs of clinical shock

Answer 13

ABC
Flat
Warm
Transfuse if required
Infuse 3.5L warmed clear fluids, initially 2l crystalloid
Bloods: FBC, xmatch, coag, renal and lfts
Temp q15min
Remaining vitals continuous monitoring
Foley and monitor out your
2 large bore cannula
?art line
?ITU
MEOWS
Documentation

Question 14

Risk factors for pph

Answer 14

Multiple pregnancy
previous PPH
PET
Macrosomia
FTP 2nd stage
Prolonged third stage
Retained placenta
Accreta
Epis
Perineal lac
GA
AMA
Asian
Obesity
Nulliparit
Abruption
Anaemia
Pyrexia in labour
Op del
Full bladder

Question 15

Carbetocin

Answer 15

100mcg IV bolus over 1 min

Use for PPH in elcs

Question 16

B-Lynch stepwise

Answer 16

Blunt semicircular needle with 1.0monocryl
Start R lower edge of the uterine incision and 3cm from R lat border
Go through uterine cavity to emerge at the upper incision margin 3cm above and 4cm from lateral border
Suture passed over to compress funds 3 to 4 cm from the right cornual border
Pass suture back posteriorly through same surface, on right side with suture lying horizontally
Suture fed posteriorly and vertically over the fundus
To lie anteriorly
Needle passed in same fashion on left side through uterine cavity and out approximately 3cm ant and below the lower incision margin on the left side

Question 17

Stepwise uterine devascularisation

Answer 17

One uterine arty
Both uterine arteries
Low uterine arteries
One ovarian artery
Both ovarian arteries

Question 18

Causes of secondary PPH

Answer 18

Endometritis
RPOC
Subinvolution of the placental implantation site
AV malformations

Question 19

Bakri mech of action

Answer 19

Controls atony in upper segment

Controls placental bleeding in LS