post-partum haemorrhage

Question 1

aetiology of PPH

Answer 1

Tone - prolonged labour, IOL, multiparity etc
trauma - operative delivery, cervical/vaginal lacerations
tissue - retained placental tissue, abnomrla placentation
Thrombin - pre eclmpsia/HELLP, amniotic fluid, sepsis, bleeding disorders, drugs, medical disorders

Question 2

management for trauma

Answer 2

clamp vessels and repair wounds
if excessive/severe - tranexamic acid and send to theatre

Question 3

management for tissue

Answer 3

retained placenta - intitiial attempts for placental seperation including oxytocin
transfer to theatre for manual removal
retained tissue - trnsfer to theatre for manual removal
potential need for USS to locate tissues

Question 4

management for tone

Answer 4

first line: syntometrine IMI, oxytocin titrated to effect
second line: carbopsrost

to theatre for ongoing compression, carboprost, and TXA

Question 5

management for thrombin

Answer 5

straight to theatre
TXA
massive transfusion protocol activation