PPH Flashcards
1
Q
what is the definition of a PPH
A
Blood loss 500ml and continuing or blood loss that causes a woman to become symptomatic.
2
Q
What are the clinical signs and symptoms
A
- general unwell feeling, lightheaded, faint
- pallor, cold peripheries, goosebumps
- HYPOtension and tachycardia (or bradycardia)
- agitation or confusion
3
Q
what is the incidence of PPH
A
1-5% of all births
4
Q
Antenatal risk factors for PPH:
A
- previous PPH
- LGA baby (>4000g)
- hypertensive disorders
- obesity
- bleeding disorders
- placenta praevia / acreta
5
Q
intrapartum risk factors for PPH:
A
- induction of labour
- prolonged 1st and or 2nd stage
- precipitate labour
- instrumental delivery
- caesarean section
- lacerations / genital tract trauma
6
Q
four causes of PPH
A
- tone
- tissue
- trauma
- thrombin
7
Q
initial management:
A
- declare emergency
- call for help
- PPH box
- delivery placenta if not already
- fundal massage
- expel clots
- give initial uterotonic (oxytocin 10iu I.M. or 5iu IV).
- baby to breast
- empty bladder - catheterise
8
Q
management if bleeding continues
A
- call 7777
- have someone checking vital signs
- have someone gain IV access - 2x 16g cannulas
- take bloods and send to lab
- continue fundal massage / expelling clots
- give another uterotonic (could give oxytocin again or syntometrine)
- start an oxytocin infusion of 40iu in 500ml bag of saline @ 125ml/hr
- examine if placenta complete
- assess perineum and genital tract from trauma
9
Q
which bloods should be taken?
A
- full blood count
- group and cross match
- coags and fibrinogen
10
Q
when should syntometrine not be given?
A
in women with hypertensive disorders
11
Q
what to do if the woman is becoming haemodynamically unstable?
A
- lie her flat
- administer oxygen
- fluid replacement - 2-3 litres of crystalloid infusion (saline or hartmanns)
- transfuse RBC if cross matched blood available - otherwise consider O-
- if haemorrhage exceeds 2000ml - activate the massive transfusion protocol
12
Q
what other measures or drugs can be given alongside uterotonics?
A
- tranexamic acid (1gram in 10 ml) I.V. slow push over 10 min or infusion in 100ml bag @600ml/hr
- control bleeding from genital tract trauma
- bimanual compression
13
Q
if uterine atony continues, what other medication could be given?
A
- carboprost 250mcg I.M. or intramyometrially can be given up to 8 doses 15 min aprt
- misoprostil 800mcg PR once only