Post partum heamorrhaeg

Question 1

What is Post partum heamorrhage (Causes)

Answer 1

PPH = blood loss over 500 SVD
primary in 24h, secondary 24-12w
4th leading cause of death

Causes-
Tone (70%)-
uterine atony (most common)- overdistended (polyhydramnions) Muscle exhaustion (prolonged), Anatomy abnormal (fribroids, praevia, abruption), Infection

Tissue (10%)-retained placental products
Retained clots in atonic uterus, Gestational trophoblastic neoplasm, abnormal placentation (accreta (strong attach), Increta (placenta into muscle wall), Percreta (through uterine wall)

Trauma (20%)-laceration of vagina, cervix, uterus

Thrombin (1%)- coagulopathy
Existing - heamophilia, WVD, ITP, TTP
Aquired-DIC, aspririn etc

secondary causes = endometriosis, retained products, abnormal placental site, trophoblastic disease

Question 2

Sx of Post partum heamorrhage

Answer 2

Primary -
Shock, aneamia
Abdo-atonic uterus (above umbilicus)
Speculum to exlude trauma
Vaginal- clots from cervix

Secondary- abdo-tender uterus
Speculum- assess bleed, is os still open
vaginal- uterine tenderness

Minor - 500-1000ml of bleed, no shock
major ->1000, shock

Question 3

Mx of Post partum heamorrhage

Answer 3

Major PPH- emergency Buzzer

Be there in a SEC

B-Bimanual compression “rub up a contraction”

Step 1- IM syntocinon )oxytocin)
2- IM ergmetrine (not if HTN/ashtma)
3- IM carboprost (not asthma)

4-6 surgucal
4- balloon tamponade
5- b lynch suture-ligate artery-> IR
60 hysterctomy