PPH

Question 1

Mrs DS presents to hospital after a home delivery and she is bleeding profusely. She is unbooked, G6 and C/S x2. Discuss your management

Answer 1

Resus
PPH causes
History
Examination
Management of PPH
Complications of PPH
HIV management
Puerperal sepsis management

Question 2

Mrs DS presents to hospital after a home delivery and she is bleeding profusely. She is unbooked, G6 and C/S x2.

Resus

Answer 2

CAB
Vitals
IV line 
100ml RL
Urinary catheter
Ward Hb
Emergency blood 
Type and screen 4units RBC and FFP
FBC, U+E, clotting profile

Question 3

Mrs DS presents to hospital after a home delivery and she is bleeding profusely. She is unbooked, G6 and C/S x2.

Causes of PPH

Answer 3

Retained products of conception (vaginal exam)
Genital tract trauma (perineum, cervix)
Uterine rupture - shock, palpate, morbidity
Uterine atony - floppy, poorly contracted
Uterine inversion - vaginal examination, cannot palpate abdominally

Question 4

Mrs DS presents to hospital after a home delivery and she is bleeding profusely. She is unbooked, G6 and C/S x2.

History

Answer 4

Obs hx
Planned, wanted, booked
Rest of history

Question 5

Mrs DS presents to hospital after a home delivery and she is bleeding profusely. She is unbooked, G6 and C/S x2.

Examination

Answer 5

Weight, BMI, MUAC

Examination

Question 6

Mrs DS presents to hospital after a home delivery and she is bleeding profusely. She is unbooked, G6 and C/S x2.

Management of PPH

Answer 6

Continue resus
Bimanual
5IU oxytocin
0.5 ergometrine
Bakri balloon
Continue to bleed - theater for evac and repair
Proceed to lap - Blynch, devascularise, TAH
Check booking bloods

Question 7

Mrs DS presents to hospital after a home delivery and she is bleeding profusely. She is unbooked, G6 and C/S x2.

Complications of massive PPH

Answer 7

Massive blood loss 
Coagulation abnormalities
Massive blood transfusion
Renal impairment
Psychological
Mortality

Question 8

Mrs DS presents to hospital after a home delivery and she is bleeding profusely. She is unbooked, G6 and C/S x2.

Management of HIV + diagnosis

Answer 8

Post test counselling
CD4
Creatinine
Staging
Start ARVs
Exclusive BF
Neonate PCR and NVP AZT regimen

Question 9

Mrs DS presents to hospital after a home delivery and she is bleeding profusely. She is unbooked, G6 and C/S x2.

Puerperal sepsis management

Answer 9

Analgesia
Cold compress
Express
Nipple care
Lactation consultant 
Check creatinine - start on bactrim