Postpartum haemorrhage Flashcards
What is postpartum haemorrhage (PPH)?
refers to bleeding after delivery of the baby and placenta
What is the most significant cause of obstetric haemorrhage?
Postpartum haemorrhage (PPH)
To be classed as PPH, what volume of blood loss needs to occur?
500ml after a vaginal delivery
1000ml after a caesarean section
2 main blood loss volume classification’s of PPH?
Minor PPH – under 1000ml blood loss
Major PPH – over 1000ml blood loss
Major PPH is blood loss over 1000ml, what are the 2 sub-types of major PPH?
Moderate PPH – 1000 – 2000ml blood loss
Severe PPH – over 2000ml blood loss
2 main time duration classifications of PPH?
Primary PPH: bleeding within 24 hours of birth
Secondary PPH: from 24 hours to 12 weeks after birth
Causes of PPH? (Remember: 4T’s)
REMEMBER: 4T’s
T – Tone (uterine atony – the most common cause)
T – Trauma (e.g. perineal tear)
T – Tissue (retained placenta)
T – Thrombin (bleeding disorder)
Risk factors for PPH?
- Previous PPH
- Multiple pregnancy
- Obesity
- Large baby (macrosomia)
- Failure to progress in the second stage of labour
- Prolonged third stage
- Pre-eclampsia
- Placenta accreta (occurs when blood vessels and other parts of the placenta grow too deeply into the uterine wall).
What measures can be carried out to reduce risk and consequences of PPH?
Treating anaemia during the antenatal period
Giving birth with an empty bladder (a full bladder reduces uterine contraction)
Active management of the third stage (with intramuscular oxytocin in the third stage)
Intravenous tranexamic acid can be used during caesarean section (in the third stage) in higher-risk patients
PPH is an obstetric emergency requiring a team of professionals, what does this team consist of?
senior midwives, obstetricians, anaesthetics, haematologists, blood bank staff and porters.
What is management to stabilise PPH in a patient?
Resuscitation with an ABCDE approach
Lie the woman flat, keep her warm and communicate with her and the partner
Insert two large-bore cannulas
Bloods for FBC, U&E and clotting screen
Warmed IV fluid and blood resuscitation as required
Oxygen (regardless of saturations)
Fresh frozen plasma is used where there are clotting abnormalities or after 4 units of blood transfusion
Treatment to stop PPH bleeding can be categorised into what 3 groups?
Mechanical
Medical
Surgical
Mechanical treatment options to stop PPH bleeding?
Rubbing the uterus through the abdomen to stimulates a uterine contraction (referred to as “rubbing up the fundus”)
Catheterisation (bladder distention prevents uterus contractions)
Medical treatment options to stop PPH bleeding?
Oxytocin (slow injection followed by continuous infusion)
Ergometrine (intravenous or intramuscular) stimulates smooth muscle contraction (contraindicated in hypertension)
Carboprost (intramuscular) is a prostaglandin analogue and stimulates uterine contraction (caution in asthma)
Misoprostol (sublingual) is also a prostaglandin analogue and stimulates uterine contraction
Tranexamic acid (intravenous) is an antifibrinolytic that reduces bleeding
Surgical treatment options to stop PPH bleeding?
Intrauterine balloon tamponade – inserting an inflatable balloon into the uterus to press against the bleeding
B-Lynch suture – putting a suture around the uterus to compress it
Uterine artery ligation – ligation of one or more of the arteries supplying the uterus to reduce the blood flow
Hysterectomy is the “last resort” but will stop the bleeding and may save the woman’s life
