PPH CPG

Question 1

what is the problem with massaging a contracted firm uterus?

Answer 1

may interfere with normal placental seperation post birth and worsed bleesing- only apply when the fundus is not firm

Question 2

what are the four ts for post partum hemoraage?

Answer 2

tone - fudal / uterine tone
truma- perinineum, vagonal
tissue- retained placenta or mebranes
thrombin - clotting disorders

Question 3

how has higher risk of PPH?

Answer 3

more than 4 pregnancies, pst hx of PPH, history of APH, large baby

Question 4

when will a fundus become firm? what should we do before this?

Answer 4

untill placnta delivered and uterus contracted- wait for 3rd stage delivery and monitor vital signs and PV bleeding

Question 5

what to do it sevre bleeding occurs 24hrs to 6 weeks post birth?

Answer 5

consult with reciving hospital for administration of oxytocin

Question 6

what do you do if there is PPH and the fundus is firm?

Answer 6

oxygen
analgesia
if BP <90 - 40ml/kg of IV fluids titrated to response- consult for further fluids, if conult not avaliable a further 20ml/kg
mx lacerations/trauma

Question 7

what to do if fundus isnt firm?

Answer 7

if placenta delivered- fundal massage woth one cupped hand apply firm pressure in a circular motion
encourage mother to empty bladder and baby to sucle breast

Question 8

what to do if the fundus doesnt firm up after massage?

Answer 8

oxytocin 10IU IM - repate after 5 minutes if bleeding continues

Question 9

what to do if administering oxytocin doesnt work?

Answer 9

external abdominal aprtic compression

Question 10

how is an external aortic abdominal compression perfomred?

Answer 10

• locate compression point aboive the umbilicus and slightly to the left
• apply downward pressure with clossed fist through abdominal wall
  evaluate effectivness by assesing palpable femoral puslse with pressure applied