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.

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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
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3
Q

what is the incidence of PPH

A

1-5% of all births

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4
Q

Antenatal risk factors for PPH:

A
  • previous PPH
  • LGA baby (>4000g)
  • hypertensive disorders
  • obesity
  • bleeding disorders
  • placenta praevia / acreta
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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
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6
Q

four causes of PPH

A
  1. tone
  2. tissue
  3. trauma
  4. thrombin
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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
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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
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9
Q

which bloods should be taken?

A
  • full blood count
  • group and cross match
  • coags and fibrinogen
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10
Q

when should syntometrine not be given?

A

in women with hypertensive disorders

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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
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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
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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
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