16 - Obs - The Puerperium - PPH

Question 1

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

Answer 1

500ml
24h
CS
10%
mort

Question 2

Aetiology

4 T’s?

Answer 2

Trauma
Tone
Thrombin
Tissue

Question 3

Aetiology
3 common causes
3 rare causes

Answer 3

common - retained placental fragments, atonic uterus, perineal trauma

rarer - uterine rupture, cervical tear, high vaginal tear

Question 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.

Answer 4

80%
contract
atonic
retained
prolonged
multiparity
overdistension
polyhydramnios
multiple

Question 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.

Answer 5

partial
uterus
collapse
external

congen
anticoag
DIC

Question 6

Aetiology

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

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

Answer 6

20%
perineal
episiotomy
high vaginal
instrumental

instrumental

Question 7

Prevention

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

Answer 7

oxytocin
3rd
60
vomiting
HTN

Question 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

Answer 8

minimal
placenta
umbilicus
uterine
walls
cervix
abdominal
overt

Question 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.

Answer 9

flat
IV
cross
volume
anaesthetic
obstetric

manually
60mins

Question 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).

Answer 10

VE
inversion
compressed
lacerations
uterine
oxytocin
trauma
GA

Question 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.

Answer 11

uterus
placenta
cervix
vagina
sutured
atony
myometrium

surgery
bed
rusch
brace
aa embolization
hysterectomy