pph_flashcards
What should be routinely offered to all women in the management of the 3rd stage of labour to reduce the risk of PPH?
Prophylactic uterotonics.
What is offered to women delivering vaginally to reduce the risk of PPH?
IM oxytocin (10 iU).
What is offered to women delivering by C-section to reduce the risk of PPH?
IV oxytocin (5 iU) ± tranexamic acid if risk factors for PPH.
What should be considered for women with increased risk of haemorrhage?
Ergometrine-oxytocin (syntometrine), contraindicated if hypertension is present.
What is the definition of minor PPH?
500-1000 mL without shock.
What should be done in the case of minor PPH?
Alert midwife in charge and first-line obstetric and anaesthetic staff, follow ABCDE approach, 1x IV access, urgent bloods (FBC, clotting, G&S, cross-match 4 units), commence warmed crystalloid infusion, HR, RR, and BP every 15 mins.
What is the definition of major PPH?
Greater than 1000 mL.
What should be done in the case of major PPH?
Call for senior help and initiate major obstetric haemorrhage MOH protocol, follow ABCDE approach, position patient flat, keep patient warm, 2x large bore IV cannulae, urgent bloods (FBC, clotting, G&S, cross-match 4 units, baseline U&E and LFTs), transfuse blood ASAP, infuse up to 3.5L warmed clear fluids until blood is available, continuous HR, BP, and RR monitoring, monitor temperature every 15 minutes, catheterise.
What should be done if the placenta is undelivered in major PPH?
Attempt removal by controlled cord traction.
What should be done if the placenta is delivered in major PPH?
Check for completeness and empty uterus and vagina of clots.
What should be done if uterine atony is the suspected cause of PPH?
Massage the uterus to stimulate contractions, follow a stepwise approach to pharmacological and surgical options.
What are the pharmacological steps to treat uterine atony in PPH?
Step 1: 5iU oxytocin (syntocinon) slow IV infusion. Step 2: 0.5mg ergometrine/syntometrine slow IV infusion or IM. Step 3: Oxytocin IV infusion (40iU in 500ml isotonic crystalloids). Step 4: IM Carboprost (contraindicated in asthmatics).
What are the surgical steps to treat uterine atony in PPH?
Step 5: Intrauterine balloon tamponade (e.g., Bakri balloon). Step 6: Other surgical measures (e.g., B-Lynch sutures, iliac artery ligation, uterine artery embolization IR, hysterectomy).
