PPH

Question 1

What are the classes of PPH?

Answer 1

Primary= >500mls within 24 hours of delivery 
Secondary= >500mls from 24 hours to 12 weeks postpartum

Question 2

What are the causes of primary PPH?

Answer 2

4Ts- tone, trauma, tissue, thrombin

Question 3

What is the most common cause of PPH?

Answer 3

Tone- inability of uterus to stop bleeding

Question 4

What can cause trauma causing PPH?

Answer 4

Perineal/vaginal injury e.g. tear
Cervical laceration
Uterine rupture
Broad ligament tear

Question 5

What causes “tissue” PPH?

Answer 5

Retention of tissue from placenta/foetus or placental abnormalities e.g. placenta accreta

Question 6

What causes “thrombin” PPH?

Answer 6

Coagulopathies- mainly DIC

Question 7

What can cause secondary PPH?

Answer 7

Retained tissues
Endometriosis
Tears/trauma

Question 8

What is classed as a major PPH?

Answer 8

Blood loss >1litre

Question 9

What are the risk factors for PPH?

Answer 9

Antepartum haemorrhage 
Obesity 
Increasing age 
Instrumental delivery 
Tear/episiotomy 
Induced labour

Question 10

What is the prevention of PPH?

Answer 10

Oxytocin or ergometrine

Question 11

What is the management of PPH?

Answer 11

Uterine massage and compression
Medical
Balloon tamponade
Surgery

Question 12

What is the medical management of PPH?

Answer 12

Oxytocin and ergometrine
Tranexemic acid
Cardoprost- synthetic prostaglandin

Question 13

When is TXA given in PPH?

Answer 13

1g given to all mothers after 500ml blood loss in vaginal deliveries

Question 14

What are the surgical options for PPH?

Answer 14

B Lynch suture

Hysterectomy- last line