Post-Partum Haemorrhage

Question 1

Define post-partum haemorrhage?

Answer 1

> 1L blood loss after birth

Question 2

What is a primary post-partum haemorrhage?

Answer 2

Loss of 500ml blood if vaginal birth and >1L if c section within 24hrs of delivery

Question 3

What is secondary post-partum haemorrhage?

Answer 3

Loss of >1L within 6 weeks after birth

Question 4

What mnemonic helps to remember post-partum haemorrhage causes?

Answer 4

4 Ts

Question 5

What are the 4 Ts?

Answer 5

Tone
- Uterine atony

Trauma
- Genital tract tear

Tissue
- Retained placental tissue

Thrombin
- Reduced after pregnancy

Question 6

What investigations should be done in a post-partum haemorrhage?

Answer 6

Primary
- Clotting screen

Secondary
- Speculum exam may help

Question 7

What is treatment of uterine atony?

Answer 7

Fundal massage

If fails –> uterotonic drugs

• Oxytocin
• Carboprost
• Ergometrine
• Misoprostol

Question 8

What uterotonic drugs can be used in uterine atony?

Answer 8

Carbaprost
Ergometrine

Misoprostol can be used in severe cases

Question 9

What is treatment of retained placental tissue –> haemorrhage?

Answer 9

Uterotonics

Surgery if fails