GTG 52: PPH

Question 1

Benefit of syntometrine?

Answer 1

Reduces minor PPH in women at risk of haemorrhage

Question 2

Who to alert to minor PPH?

Answer 2

First line obstetric and anaesthetic staff and midwife in charge

Question 3

Measures for minor PPH?

Answer 3

One 14 gauge cannula
20ml blood for G&S, FBC, coag screen
HR/BP/RR every 15 minutes
Commence warmed crystalloid infusion

Question 4

Measures for major PPH?

Answer 4

ABC
Flatten
Keep warm
Transfuse asap if required, until blood infuse up to 3.5L warmed clear fluids, initially 2L of warmed crystalloid or colloid.

Question 5

Criteria for giving FFP?

Answer 5

if no haemostatic results available and bleeding continuing then after 4 RBC given FFP 12-15ml/kg

Early FFP considered if suspected coagulopathy, such as AFE or placental abruption

If APTT/PT >1.5x normal then in excess of 15ml/kg FFP.

Question 6

When should platelets be transfused?

Answer 6

If <75

Question 7

Initial protocol for major PPH?

Answer 7

Venepuncture 20ml for XM 4 units, FBC, coag, UEs

Temp every 15 minutes

Continous HR/BP/RR

Foley’s catheter

Two cannula

Consider arterial line monitoring

Question 8

Treatment of secondary PPH?

Answer 8

Vaginal microbiology (high vaginal and endocervical)
Antimicrobial therapy should be initiated when endometritis suspected

Pelvic USS may help to exclude RPOC

Question 9

Secondary PPH definition?

Answer 9

24 hours to 12 weeks abnormal or excessive bleeding.