16 - Obs - The Puerperium - PPH Flashcards Preview

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Flashcards in 16 - Obs - The Puerperium - PPH Deck (11):
1

1’ PPH = loss of >? blood 1000ml after ? ?). ?% women. Major cause of maternal ?

500ml
24h
CS
10%
mort

2

Aetiology
4 T's?

Trauma
Tone
Thrombin
Tissue

3

Aetiology
3 common causes
3 rare causes

common - retained placental fragments, atonic uterus, perineal trauma

rarer - uterine rupture, cervical tear, high vaginal tear

4

Aetiology
Uterine: ?%. Uterus fails to ?
properly, as it’s ? or ?
placenta/part of placenta. Atony more common w ?
labour, grand ? and ? of uterus (? and ? preg) and fibroids.

80%
contract
atonic
retained
prolonged
multiparity
overdistension
polyhydramnios
multiple

5

Aetiology

Retained Placenta: 2.5% delivs. ? separation -> blood accum in ?, which rises. ? may occur in absence of ? loss.

Coagulopathy: Rare. ?
disorders, ? therapy or ??? all cause PPH.

partial
uterus
collapse
external

congen
anticoag
DIC

6

Aetiology

Vaginal: ?%. Bleeding from ?
tear or ? obvious, ? ? tear considered, esp if ? deliv.

Cervical Tears: Rare, but ass w precipitate labour and ?
deliv.

20%
perineal
episiotomy
high vaginal
instrumental

instrumental

7

Prevention

Routine use of ? in ? stage reduces incidence by ?%. As effective as ergometrine, which often causes ?, and is contraindicated in ? women.

oxytocin
3rd
60
vomiting
HTN

8

Clinical Features

Blood loss should be ? after deliv of ?. Enlarged uterus above ? suggests ? cause. Vaginal ? and ? inspected for tears. Blood loss can be ?– collapse w/o pain if ?bleeding

minimal
placenta
umbilicus
uterine
walls
cervix
abdominal
overt

9

MGMT

Resuscitate: Pt lied ?, ??
access, ? match and blood ?
restored. ?, haematological and senior ? help.

Retained placenta: Removed ? if bleeding or not expelled as normal within ?mins.

flat
IV
cross
volume
anaesthetic
obstetric

manually
60mins

10

MGMT
To ID and Treat cause:
?? to exclude rare uterine ?
and uterus bimanually ?. Vaginal ? are palpable. ?cause common and ? given IV to contract uterus if no ?. If failure, examine inder ??(EUA).

VE
inversion
compressed
lacerations
uterine
oxytocin
trauma
GA

11

MGMT

EUA: cavity of ? explored for retained ?, then ? and ?
inspected for tears -> ?. If uterine ? persists, PGF2a injected into ?.

Persistent haemorrhage despite trt: needs ?. Bleeding from placental ? may respond to placement of a ? balloon. Other methods: ? suture and uterine ? ?. ? if failure.

uterus
placenta
cervix
vagina
sutured
atony
myometrium

surgery
bed
rusch
brace
aa embolization
hysterectomy

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