PPH & Maternal Injuries

Question 1

What is the definition of Postpartum Hemorrhage?

Answer 1

1) Blood loss in excess of 500cc in vaginal deliveries and in excess of 1,000cc in abdominal deliveries

2) Any blood loss that has the potential to produce hemodynamic instability

Question 2

Postpartum Hemorrhage is divided into:

Answer 2

1) Primary
2) Secondary

Question 3

What is primary Postpartum Hemorrhage?

Answer 3

Within 24 hours of delivery

Question 4

What is secondary Postpartum Hemorrhage?

Answer 4

After 24 hours of delivery

Question 5

Incidence of Postpartum Hemorrhage?

Answer 5

About 5% of all deliveries

Question 6

What are some antepartum predisposing risk factors for Postpartum Hemorrhage?

Answer 6

1) Previous PPH or manual removal
2) Abruption/previa
3) Fetal demise
4) Gestational hypertension
5) Overdistended uterus
6) Bleeding disorder

Question 7

What are some intrapartum predisposing risk factors for Postpartum Hemorrhage?

Answer 7

1) Operative delivery
2) Prolonged or rapid labor
3) Induction or augmentation
4) Chorioamnionitis
5) Shoulder dystocia (Entrapment)
6) Internal podalic version
7) Coagulopathy

Question 8

What are some postpartum causes of Postpartum Hemorrhage?

Answer 8

1) Lacerations or episiotomy
2) Retained placenta/placental abnormalities
3) Uterine rupture/inversion
4) Coagulopathy

Question 9

What are the causes of primary Postpartum Hemorrhage?

Answer 9

1) Placental site hemorrhage
a) Atonic PPH
b) Retention of placenta & clot
2) Extra placental (traumatic)
3) Uterine inversion
4) Bleeding tendency

Question 10

What are the causes of secondary Postpartum Hemorrhage?

Answer 10

1) Retention of placental tissue
2) Uterine sub involution
3) Choriocarcinoma

Question 11

MOST COMMON CAUSE OF PRIMARY PPH?

Answer 11

UTERINE ATONY

Question 12

What can cause uterine atony?

Answer 12

1) Over-distention of the uterus (Multiple pregnancy, large baby, and Polyhydramnios)
2) Antepartum Hemorrhage
3) Prolonged labor
4) Multiparity
5) Precipitate labor
6) Idiopathic
7) General anesthesia

Question 13

What is Uterine sub involution?

Answer 13

Failure of the uterus to return to its normal pre-pregnancy size

Question 14

What can cause Uterine sub involution?

Answer 14

1) Endometritis
2) Uterine Myoma
3) Placental tissue
4) Blood clot

Question 15

What is the etiology of Postpartum Hemorrhage?

Answer 15

1) Tone - uterine atony
2) Tissue - retained tissue/clots
3) Trauma - laceration, rupture, inversion
4) Thrombin - coagulopathy