Puerperium: PPH

Question 1

How can PPH be divided

Answer 1

Primary PPH

Secondary PPH

Question 2

What is primary PPH

Answer 2

> 500ml in first 24h following delivery

Question 3

What is minor PPH

Answer 3

500-1000

Question 4

What is major PPH

Answer 4

> 1000

Question 5

What is secondary PPH

Answer 5

Blood loss in 24h to 12W delivery

Question 6

What are 3 causes of secondary PPH

Answer 6

Endometritis
Retained placenta
Abnormal involution of placenta

Question 7

What is a mnemonic to remember causes of PPH

Answer 7

4T’s

Question 8

What are the 4T’s of PPH

Answer 8

Tone
Tissue
Trauma
Thrombin

Question 9

What is the most common cause of PPH

Answer 9

Impaired tone

Question 10

What is uterine atony

Answer 10

Failure of uterus to contact following delivery

Question 11

What are 3 maternal RF for uterine atony

Answer 11

> 40
BMI >35
Asian

Question 12

What are 3 causes that cause over-distention of the uterus lead to impaired contraction

Answer 12

Polyhydramnios
Macrosomia
Multiple pregnancy

Question 13

What are 2 factors in labour that leads to uterine atony

Answer 13

Prolonged

Induction

Question 14

What are 3 placenta factors leading to PPH

Answer 14

Placenta praevia
Placental abruption
Previous PPH

Question 15

What is the ‘Tissue’ cause of PPH

Answer 15

Retinaed placenta

Question 16

What is the problem with retained tissue

Answer 16

Prevents uterus from contracting

Question 17

What type of trauma usually causes PPH

Answer 17

Trauma during delivery (eg. tears)

Question 18

What are risk factors for trauma in PPH

Answer 18

Instrumentation

Episiotomy

Question 19

What does ‘thrombin refer to’

Answer 19

Vascular and Coagulation disorders increasing risk of PPH

Question 20

What 3 vascular abnormalities increase risk of PPH

Answer 20

Pre-eclampsia
HTN
Placental abruption

Question 21

What coagulopathies increase risk PPH

Answer 21

VWD, haemophilia

Question 22

How does PPH present clinically

Answer 22

Vaginal bleeding

Symptoms anaemia: breathlessness, pallour, light-headedness

Question 23

What are signs of PPH

Answer 23

Tachypneoa
Tachycardia
Hypotension
Prolonged capillary refill

Question 24

What is a mnemonic to remember management of PPH

Answer 24

TRIM

Teamwork
Resuscitation
Investigation
Measures to address bleeding

Question 25

How should PPH be approached

Answer 25

A-E

Question 26

What should be given in PPH independent of cause

Answer 26

A: Oxygen (15L via non re-breathe mask)
C: 2-large bore cannulas, Fluids (up to 2L), Blood products if required

Question 27

What is first-line for uterine atony in PPH

Answer 27

Bimanual compression

Question 28

What must be done before bimanual compression

Answer 28

Catheterise women

Question 29

Explain bimanual compression

Answer 29

One hand is inserted into anterior fornix and other compresses outer abdominal wall to manually compress the uterus - which stimulates contraction

Question 30

What pharmacological measures are used to compress uterus

Answer 30

Syntometerine

Carboprost

Question 31

What is carboprost

Answer 31

PGF2A analogue

Question 32

What two surgical measures may be required to stop PPH in uterine atony

Answer 32

• Intrauterine balloon tamponade

- B Lynch suture

Question 33

What is used to manage trauma in PPH

Answer 33

repair laceration

Question 34

What reduces risk of PPH

Answer 34

Active management of third-stage labour

Question 35

What is used to manage third-stage labour

Answer 35

5IU Oxytocin IM

Question 36

What is given to women having a C-Section to prevent PPH

Answer 36

IV oxytocin