The Puerperium

Question 1

Definition of primary and secondary post partum haemorrhage (PPH):

• Estimated Blood Loss >___ml
• Primary ___hrs but

Answer 1

• > 500ml
• <24hrs = primary
• > 24hrs but < 6 weeks

Question 2

What are the 4 Ts of causes of PPH?

Answer 2

Tone (atony and floppy -> bleed)
Tissue (check membranes for completion, RPOC)
Trauma (tears, if previous c-section, scar may have opened, inverted uterus)
Thrombin (pre-existing VWD, ITP, LMWH given, DIC)

Question 3

PPH management

• immediate:
• medical:
• surgical:

Answer 3

• immediate: ABC resus, uterine massage, correct 4 Ts
• medical: syntocinon, ergmoetrine, carboprost, misoprostol, tranexamic acid
• surgical: EUA + repair, Bakri balloon into uterus to compress placental bed, B-lynch suture, UAE (uterine artery embolism) , Hysterectomy

Question 4

Sepsis = infection w systemic manifestations

-suggest 6 sx

Answer 4

• feel unwell
• fever or hypothermia
• high HR, low BP, low urine output
• high RR, low saturations, acidosis and trying to breath off CO2
• decreased consciousness levels
• abdo pain/localising features