Postpartum haemorrhage Flashcards
What is counted as a PPH?
- 500ml after a vaginal delivery
- 1000ml after a caesarean section
Classifications of PP haemorrhage
- Minor PPH – under 1000ml blood loss
- Major PPH – over 1000ml blood loss
Major PPH can be further sub-classified as:
* Moderate PPH – 1000 – 2000ml blood loss
* Severe PPH – over 2000ml blood loss
It can also be categorised as:
* Primary PPH: bleeding within 24 hours of birth
* Secondary PPH: from 24 hours to 12 weeks after birth
Cuases PPH
4 Ts
T – Tone (uterine atony – the most common cause)
* T – Trauma (e.g. perineal tear)
* T – Tissue (retained placenta)
* T – Thrombin (bleeding disorder)
Risk factors PPH
- Previous PPH
- Multiple pregnancy
- Obesity
- Large baby
- Failure to progress in the second stage of labour
- Prolonged third stage
- Pre-eclampsia
- Placenta accreta
- Retained placenta
- Instrumental delivery
- General anaesthesia
- Episiotomy or perineal tear
Preventative measures reduce risk and consequences of PPH
Treating anaemia during antenatal period
Give birth with empty bladder
Active management of third stage - IM oxytoicn
What can be used in C section higher risk patients preventing PPH?
IV tranexamic acid
Why does giving birth on an empty bladder reduce the risk of PPH?
Full bladder reduces uterine contraction
Management to stabilise patient with PPH
Resus - A-E
Lie the woman flat, keep warm, communicate with her and partner
Insert two large bore cannulas
Bloods - FBC, U+Es, clotting screen
Groups and cross match 4 units
Warmed IV fluid and blood resus as required
Oxygen - regardless of saturations
Fresh frozen plasma - clotting abnormalities after 4 units of blood transfusion
Mechanical treatments to stop the bleeding
Rubbing uterus through abdomen - stimulates uterine contraction (referred - rubbing fundus)
Catheterisation (bladder distension prevents uterus contraction)
Medical treatment options for PPH treatment
Oxytocin - slow injection followed by continious infusion
Ergometrine - stim smooth muscle contraction
Carboprost - IM - prostaglandin analogue
Misoprostol - sublingual - prostaglanding anali=ogue
Tranxemac acid - IV - antifibrinolytic that reduces bleeding
What is cardoprost cautioned in and why
Asthma - its a prostaglandin analogue
What is IV infusion of oxytocin given as
40 units in 500mls
Surgical options treatment for PPH
intrauterine balloon tamponade
B-lynch suture
Uterine artery ligation
Hysterecotmy
What is a beta lynch suture
Suture around uterus to compress it
Why does secondary PPH occur
RPOC
INfection eg endometritis
