PPH GTG Flashcards
Risk factors for PPH?
Multiple pregnancy
Previous PPH
PET
Fetal macrosomia
Failure to progress in second stage
Prolonged 3rd stage
Retained placenta
Placenta accreta
Episiotomy
GA
Who should be offered active management of 3rd stage?
All women as they reduce risk of PPH
Routine uterotonic in vaginal delivery?
10iu oxytocin IM after shoulder or baby delivered (before cord is cut)
Routine uterotonic in caesarean section?
Oxytocin 5iu slow IV
What should women at increased risk of PPH receive for prophylaxis?
Ergometrine-oxytocin in absence of hypertension
1g IV TXA
When to give fresh frozen plasma FFP?
After 4 units RBC
Or if suspected coagulopathy e.g. placental abruption or amniotic fluid embolism
If prothrombin time or activated partial thromboplastin time (APTT) are prolonged and ongoing haemorrhage, give 12-15ml/kg of FFP
How to monitor and replace fibrinogen in ongoing PPH?
Given when plasma fibrinogen is <2g/L
Cryoprecipitate should be used to replace fibrinogen
Give 2 pools
When should platelets be transfused in PPH?
Platelets <75 x10^9/L
1st line surgical intervention in uterine atony?
Intrauterine balloon tamponade
How to manage secondary PPH?
HVS and endocervical swabs to assess vaginal microbiology
Antibiotics if endometritis suspected
Pelvic ultrasound to assess RPOC
SEVAC if retained placental tissue
When should a formal clinical incident review take place in PPH?
blood loss >1500ml
When should carbetocin be used?
Licensed for prevention of PPH at CS
BUT no statistically significant difference compared to oxytocin so not RCOG recommended
What fluids to give in major PPH
2 litres warmed isotonic crystalloid
Then further 1.5L isotonic crystalloid or colloid (succinylated gelatin)
