Question 4: PPH

Question 1

List the causes of PPH

Answer 1

Tone - atony of uterus
Trauma - genital tract trauma
Thrombus - coagulation issue such as DIC
Tissue - retained products

Question 2

How would you begin assessing?

Answer 2

Assess mum for shock - is she tachycardic + hypotensive? Does she appear pale, shaky. Try to determine amount of blood loss - quantify. ?pooling

Initiate resus if needed - IV fluids.

In palmerston north, do the emergency bell for added help.

Question 3

If mum is stable, what will you do next?

Answer 3

Brief history
- this pregnancy, L+D ?any tear identified
- gynae hx
- PMHx particularly if asthmatic or HTN as this would change preference of medications.
- Current meds e.g. anticoags such as clexane
- allergies

Question 4

What exam would you do?

Answer 4

Uterine tone/height
Lengthening of umbilical cord
Look at genital tract for any tears

Question 5

What will you do re: placenta?

Answer 5

Attempt controlled cord traction

involves traction on the umbilical cord while maintaining counter‐pressure upwards by placing a hand on the lower abdomen ONLY if signs of placental seperation

Question 6

How would you initiate resuscitation if required?

Answer 6

DRS ABC

Airway (O2), breathing if required
Circulation - 1-2 large bore cannula.

Take bloods (FBC, U+E, coags, group + hold)

Initiate massive haemorrhage pathway if required
Involve haematologist if coag abnormalities/on clexane

IV fluids

Other medications: tranexamic acid, misoprostil, oxytocin, ergometrine

Question 7

Outline next management if successful versus not successful

Answer 7

Successful: inspect placenta, check for no missing parts
Unsuccessful: need to go to OT for manual removal or bakri-balloon.
B-lynch (special kind of stitch)
Embolise
Hysterectomy