Women's Health : Postpartum Haemorrhage Flashcards
What is postpartum haemorrhage (PPH)?
Loss of more than 500ml of blood from the genital tract within 24 hours of delivering a baby.
What are the classifications of PPH by volume?
Minor, Major, Moderate, Severe
What is Minor PPH?
500-1000ml
What is Major PPH?
> 1000ml
What is Moderate Major PPH?
1000-2000 ml
What is Severe Major PPH?
> 2000ml
What are the four Ts causes of PPH?
Tone, Tissue, Trauma, Thrombin
What is the commonest cause of PPH?
Uterine atony
What can affect tone in regards to causing PPH?
Inadequate contraction of the uterus after separation of the placenta leads to profuse bleeding from the decidua.
What are the causes of uterine atony?
multiple pregnancy, macrosomia, polyhydramnios, retained placenta, prolonged second stage of labour.
What can affect tissues in regards to causing PPH?
(tissue retained in uterus): Typically part of placenta, sometimes retention of part of foetal / maternal membranes. Prevents proper uterine contraction and resulting vessel occlusion.
What are the causes of tissue retention in uterus?
placenta praevia, placenta accreta spectrum, succenturiate placental lobe, preterm delivery
How does Trauma affect PPH?
Trauma to genital tract leading to bleeding - includes caesarean section.
What are the causes of trauma in PPH?
vulvovaginal tears, instrumental delivery, episiotomy.
How does Thrombin affect PPH?
Normal bleeding worsened by pre-existing / obstetric coagulopathy / thrombocytopenia.
What are the causes of Thrombin affecting PPH?
pre-eclampsia, HELLP syndrome, DIC, puerperal sepsis, von Willebrand disease, dilutional coagulopathy (resuscitation with high volumes of crystalloid).
What is the management of minor PPH?
IV access with 14-gauge cannula, G+S, FBC, coagulation screen, Frequent observations every 15 minutes, Warmed crystalloid infusion.
What is the management of major PPH?
As for minor PPH, plus: Lie patient flat, give high flow oxygen, O-negative blood as soon as possible - warmed crystalloid until blood is available, Ongoing haemorrhage: blood component transfusion - FFP, platelets, cryoprecipitate - guided by blood counts and clotting profile.
In both Minor and Major PPH, what is the treatment of underlying cause?
Fundal massage, Catheterisation, Oxytocin and ergometrine, Carboprost (uterotonic), Misoprostol.
In both Minor and Major PPH, what are the second line surgical measures?
Intrauterine balloon tamponade, Haemostatic suturing (B-Lynch), Uterine devascularization / arterial ligation, Hysterectomy.
