PPH + postpartum contraception Flashcards
definition of post partum haeorrhage
blood loss;
*>=500ml after vaginal delivery
*>=1000ml after c-section
causes of PPH
4 Ts
- Tone - uterine atony (commonest)
- trauma - perineal tear
- tissue - retained placenta
- thrombin - clotting/bleeding disorder
risk factors for PPH
previous PPH
prolonged labour
pre-eclampsia
increased maternal age
polyhydramnios
emergency c-section
placenta praevia, accreta
macrosomia
(nulliparity)
overview of PPH management
seniors immediately
ABC approach
mechanical mx - rub fundus
medical mx
surgical mx
ABC approach in PPH
2 peripheral cannulae, 14 gauge
lie woman flat
bloods inclusing group + save
commence warmed crystalloid infusion
(fresh frozen plasma if there are clotting abnormalities or after 4 units of blood transfusion)
mechanical mx in PPH
- palpate uterine fundus+ rub it to stimulate contractions (“rubbing up the fundus”)
- catheterisation to prevent bladder distension + monitor urine output
PPH preventative measures
- treat anaemia in antenatal
- give birth with empty bladder - full bladder reduces uterine contraction
- active management of 3rd stage - IM oxytocin
- IV tranexamic acid - can be used during caesarean in 3rd stage in high risk people
medical mx of PPH and the contraindications of these
IV oxytocin - slow IV injection, then IV infusion
ergometrine IV/IM - NO in hypertension
carboprost IM - No in asthma
misoprostol sublingual
surgical mx of PPH
if medical mx fails
1st line = intrauterine balloon tamponade
others; B-lynch suture, ligation of uterine arteries, internal ilic arteries
severe –> hysterectomy
secondary PPH
occurs between 24hrs - 12wks
–> typically due to retained placental tissue or endometritis
when do women require contraception after givng birth
after day 21
IUS/IUD postpartum insertion
can be inserted within 48hrs or after 4 weeks post childbirth
lactational amenorrhoea method (LAM)
98% effective if the women is FULLY breastfeeding (no supplementary feeds), amenorrhoeic + <6months post-partum
when is the COCP contraindicated in the post partum period
if breastfeeding <6weeks post-partum
–> UKMEC4
should not be used in first 21days due to increased VTE risk
- after day 21 additional contraception should be used for 7 days
can use the COCP as contraception post partum if breastfeeding
UKMEC2 - if BF 6wks-6months post partum
NOT before 6 weeks
COCP affect on breast mile
may reduce breast milk production in lactating mothers
POP as post partum contraception
those breastfeeding and not can start POP at anytime postpartum
after day 21, additional contraception should be used for 1st 2 days
small amount of progestogen enter breast milk but it not harmful to child
risk of an inter-pregnancy of <12months (between childbirth + conceiving again)
- pre term birth
- low birth weight
- small for gestational age
