PPH - Post Partum Haemorrhage

Question 1

How much blood constitutes a minor/major PPH?

Answer 1

minor <1000ml

major >1000ml

Question 2

Primary and secondary PPH is within which timeframes?

Answer 2

Primary - within 24hrs

Secondary - 24hrs-12wks

Question 3

What are the four T’s that cause it?

What is the most common?

Answer 3

T- tone - uterine atony
T - trauma (perineal tear)
T - tissue (placenta retained)
T - thrombin (bleeding disorder)

Tone - 70%

Question 4

What is the minimum amount of blood that has to be lost to be classified as PPH?

Answer 4

500ml

Question 5

Why does uterine atony cause PPH?

Answer 5

Failure of uterus to properly contract post birth means uterine arteries don’t constrict

This is the most common cause of PPH

Question 6

To reduce risk what can be done:

• during pregnancy
• during labour
• during passing of the placenta

Answer 6

Pregnancy - manage anaemia
Labour - birth with empty bladder (full bladder reduces strength of uterine contractions)
3rd stage - active management of passing placenta
- involving using IM oxytocin

Question 7

What kind of drug is Syntocinon?

Answer 7

Oxyctocin

Question 8

A patient losing lots of blood needs team management. You may have to activate major haemorrhage protocol. For each of the following issues state how you would manage it?

• first look at patient
• IV access?
• Stopping blood loss
• Replacing lost blood
• O2 saturations
• Finding cause of PPH

Answer 8

First - ABCDE

IV access - 2 wide bore IV access - needed as lots of fluids are gonna be required

Replacing lost blood - cross match 6 units of blood

O2 - High flow O2 regardless of O2 sats

Cause of PPH - consider the 4 T’s

Stopping blood loss
Mechanical
- rubbing the uterus through the abdo to stimulate uterine contraction
Medical
- 40 units of oxytocin
- prostaglandin analogue (Carboprost IM or misprostol PR)
Surgical
- Intrauterine balloon tamponade (balloon to put more pressure in uterus)
- B-lynch suture (suture around uterus to compress it)
- Uterine artery ligation (reduce blood flow)
- Hysterectomy = LAST RESORT

Question 9

What are the two most common causes of secondary PPH?

Answer 9

• Retained products of conception (remaining fetal or placental tissue)
• Infection