Primary post partum haemorrhage

Question 1

Definition

Answer 1

>500ml blood/1000ml after caesarean Within 24 hours

Question 2

Epidemiology (cause + prevalence)

Answer 2

5-7% of deliveries

Uterine atony 90%; also trauma and clotting abnormalities

Question 3

Risk factors

Answer 3

Previous PPH

Prev C-section

Anaemia

Increased maternal age

APH

Polyhydramnios

Placenta praevia, accreta or percreta

Multiple pregnancy

Macrosomia

Grand multiparity

(emergency) C-section or instrumental delivery

Prolonged and induced labour

Ritodrine (beta2agonist - used for tocolysis)

Question 4

Causes

Answer 4

4 Ts

Tone (uterine atony) Trauma Tissue (retained placenta) Thrombin (coagulopathies)

Question 5

Clinical features

Answer 5

Signs of shock/blood loss Enlarged uterus Tears

Question 6

Initial management

Answer 6

Assessment: ABCDE, monitoring, cause and extent of bleeding,alert seniors and MDT Stop the bleeding: Active management of third stage, syntocinon/ergometrine, bimanual compression of uterus, compress uterus, urinary catheter, carboprost injection, ligation of uterine/internal iliac arteries, hysterectomy can be life-saving Fluid replacement: Rapidly, IV, give blood

Question 7

Ongoing management

Answer 7

Intensive monitoring Carboprost Surgical measures Treat coagulopathies Uterine packing/tamponade Vessel ligation/radio-emoblisation Emergency hysterectomy