Post partum haemorrhage

Question 1

Blood loss to be considered post partum haemorrhage

Answer 1

Greater than 500 mls

Question 2

Time frame of primary post partum haemorrhage

Answer 2

24 hours

Question 3

Most common cause of post partum haemorrhage

Answer 3

Uterine atony

Question 4

Risk factors for post partum haemorrhage

Answer 4

previous PPH
prolonged labour
pre-eclampsia
increased maternal age
polyhydramnios
emergency Caesarean section
placenta praevia, placenta accreta
macrosomia
ritodrine (a beta-2 adrenergic receptor agonist used for tocolysis)

Question 5

Management for post partum haemorrhage

Answer 5

ABC including two peripheral cannulae, 14 gauge
IV syntocinon (oxytocin) 10 units or IV ergometrine 500 micrograms
IM carboprost
if medical options failure to control the bleeding then surgical options will need to be urgently considered
the RCOG state that the intrauterine balloon tamponade is an appropriate first-line ‘surgical’ intervention for most women where uterine atony is the only or main cause of haemorrhage
other options include: B-Lynch suture, ligation of the uterine arteries or internal iliac arteries
if severe, uncontrolled haemorrhage then a hysterectomy is sometimes performed as a life-saving procedure

Question 6

First line non pharmological management of PPH

Answer 6

Bimanual uterine compression

Bladder emptied via catheter

Question 7

First line pharmological management of PPH

Answer 7

IV synthetic oxytocin

Question 8

4TS of PPH causes

Answer 8

Tone
Tissue
Trauma
Thrombin

Question 9

Time frame of Secondary Post Partum haemorrhage

Answer 9

after 24 hours to 12 weeks

Question 10

Cause of secondary PPH

Answer 10

Retained placental tissue or endometriosis