PPH revision Flashcards
What is the definition of a primary postpartum haemorrhage?
Blood loss of 500mls or more within 24h of birth. (A major PPH = blood loss >1000mls)
What is a secondary PPH?
Blood loss of 500mls or more 24h to 12 weeks postpartum
Who is high risk for having a PPH?
Those who have:
- Previous PPH
- Placenta Praevia/accreta
- Fibroids
- Polyhydramnios
- Anaemia
- Haemorrhagic disorders
- Women who decline blood products
- Multiple pregnancy
- Obesity
What are the 4 T’s that are usually responsible for the cause of PPHs?
- Tone. Uterine muscle contracts to prevent bleeding. An atonic uterus causes bleeding and predisposes to uterine inversion.
- Tissue. Retained products or clots that prevent contractions of the uterus.
- Trauma. Vaginal/cervical lacerations.
- Thrombin. Clotting factor.
Why is it important to monitor fundal height postnatally?
As a non involuting uterus can be sign that products remain in the uterus.
Initial management of a major PPH- Call for help. Who do you need?
-Senior Midwife, Obstetrician, anaesthetist, scribe and a haematologist
A woman is having a PPH. You’ve pulled the red buzzer to alert help, what should you do next?
Lay the woman flat and administer 15L of high flow oxygen via mask. Massage the uterus to encourage it to contract and expel clots.
IV access is needed- what cannulas are used?
Two large-bore (grey) cannulae
Bloods need to be taken, what is needed?
- FBC (Lavender/purple)
- Clotting screening (Blue)
- Group and save (Pink)
- X match 4 units (Pink)
A X match can take 45-60 minutes to complete in a lab. In an absolute emergency, what blood type can be given to a patient?
o negative
A woman having a PPH requires rapid fluid replacement. What should be given?
Two litres of crystalloid- Hartmann’s or 0.9% saline
What needs to be monitored regularly throughout this emergency?
The patients respiratory rate, pulse, Bp and O2 sats.
If the uterus is relaxed, what technique can be applied until the bleeding is controlled and the uterus contracts?
Bimanual compression. One hand presses deeply into the abdomen to apply pressure to the posterior wall of the uterus (behind fundus) whilst the other hand, made into a fist, is inserted into the vagina to apply pressure against the anterior wall of the uterus.
What uterotonics can/should be given during management of a PPH?
- Syntocinon, 10iu (1ml) IM or slow IV injection
- or Syntometrine, 5iu- 1ml (500mcg ergometrine) IM (contraindicated if raised BP)
- Syntocinon infusion, 40iu given by IV infusion via pump over 4 hours.
What should be given alongside uterotonics ASAP during management of a major PPH? What Dose?
Tranexamic Acid, 1g as slow IV injection, given at a rate of 1ml/minute (Given over 10 minutes). Can be repeated after 30 mins if PPH continues.
