PPH Flashcards
Define
WHO (2012), an incident of abnormal or excessive blood loss from the genital tract, either over 500ml in volume or loss which adversely affects the maternal physiology lowering blood pressure and haematocrit levels.
Primary and Secondary
Primary > within 24 hours of delivery
Secondary> from 24 hours to 6 weeks
Incidences
0.78 per 100,000 deaths. Second highest cause of Maternal Death (MBRRACE)
Categories
Minor- >500mls- 1000mls. Major 1000mls - 2000mls
Massive >2000mls.
Risk factors
Unpredictable but risk factors include: Raised BMI Anaemia Coagulopathy Pre-eclampsia/PIH Previous PPH Prolonged 1st/2nd stage. APH Instrumental Shoulder Dystocia Breech
Normal monitoring
Normal PN care involves monitoring PV loss. If concerns begin obs every 15 minutes to observe for signs of compensation e.g. raised resps or HR. Plot on MEOWS
Why is prompt recognition important?
Blood loss can occur very quickly >1000mls lose the ability to compensate
Potential outcome of PPH
Hypovolaemic shock> loss of blood> reduced blood volume>decreased perfusion> anaerobic respiration > cell dysfunction> increase lactate, low pH> SIRS> MODS> death.
Tone
Tone- Atonic uterus- overextended (multiple pregnancy, polyhydramnious, macrosomic fetus), prolonged labour. consider drugs e.g. hypertensive which can affect tone
If uterus is not well contracted the arteries are not ligated. 70% of PPH.
Tissue
Retained products in uterus > consider is placenta complete, ragged membranes? impairs the ability to contract. 36% of PPH.
Trauma
Lacerations to the perineum/vagina/cervix. Most common with instrumental. Previous uterine surgery e.g. section (rupture) 18%
Thrombin
Coagulopathy- 1.5% of PPH. Assess blood on bed, is it clotting? history of coagulopathy e.g. von willebrands. Anticoagulants? Preeclamptic> PLT count DIC?
