PPH management

Question 1

List 8 risk factors for poor uterine tone (causing PPH)

Answer 1

• quick labour
• long labour
• LGA baby
• polyhydramnios
• multiple pregnancy
• fibroids
• grand multip
• intra uterine infection
• uterine relaxing agents such as MgS04 and tocolytic agents

Question 2

List a risk factor for traumatic PPH?

Answer 2

• operative vaginal delivery

Question 3

List the major risk factor for retained tissue causing PPH

Answer 3

abnormal placentation

Question 4

List 5 risk factors for coagulopathy or thrombin causing PPH

Answer 4

PET particularly HELLP
placental abruption
AFE
Sepsis 
bleeding disorders
drugs - aspirin/heparin

Question 5

What are the medications in order that you should give for treatment of PPH>

Answer 5

• syntocinon bolus
• syntocinon infusion
• syntometrine (unless HTN)
• carboprost (x8 every 15 mins)
• consider misoprostol

Question 6

what is the formulation of syntometrine?

Answer 6

5 units oxytocinon with 500mcg of ergometrine in a 1 ml ampoule
Should always be given IM

Question 7

what is the dose of misoprostol for PPH management?

Answer 7

800-1000mcg tablets rectal (4-5 tablets)

Question 8

what is the dose of carboprost?

Answer 8

250mcg IM given every 15 mins up to 8 doses

Question 9

Describe placement of a B Lynch suture

Answer 9

• open uterus
• exteriorise
• empty cavity of placenta
• have assistant apply bimanual compression
• place absorbable suture 3cm below the left angle and bring out 3cm above the left angle
• run suture vertically over uterus
• perform a horizontal suture across the posterior LUS
• run suture back over vertically
• place suture above right angle by 3cm and come out below right angle by 3cm
• tie knot anteriorly