Puerperium Flashcards
Define a primary post-partum haemorrhage
> 500ml of blood lost within 24 hours of delivery
Define a minor PPH
500-1000ml blood loss
Define major PPH
> 1000ml blood loss
What are the four Ts of primary PPH causes?
Tone
Tissue
Trauam
Thrombin
What are the main risk factors for uterine atony?
>40yrs BMI >35 Asian Uterine overdistension IOL Prolonged labour Placental problems
How does retention of placental tissue cause PPH?
Prevents uterus contracting
Which symptoms may accompany PPH?
Dyspnoea
Dizziness
Palps
How is uterine atony managed?
Bimanual compression to stimulate contraction
Drugs
Surgical measures
Which medications may be used in uterine atony?
Syntocinon
Erogmetrine
Carboprost
Misoprostol
Define secondary post-partum haemorrhage
Excessive vaginal bleeding form 24 hours post-delivery to 6 weeks post partum
What are the main causes of secondary PPH?
Uterine infection
Retained tissue
Abnormal involution of placenta
Trophoblastic disease
Which symptoms may endometritis-induced PPh present with?
Fever
Rigors
Lower abdo pain
Foul smelling lochia
What is lochia?
Normal discharge from uterus following birth
What investigations should be performed in secondary PPH?
Speculum
High vaginal swab
Usual blood tests
Pelvic USS
If a patient presens with fever, rigors, foul smelling lochia and uterine tenderness - what diagnosis should be suspected?
Endomyometritis
