postpartum disorders Flashcards
primary PPH
blood loss of >500ml within 24 hrs of delivery
severe PPH
blood loss of >2000ml within 24 hrs of delivery
secondary PPH
blood loss >500ml from 24 hrs postpartum to 6 weeks
causes of secondary PPH
retained tissue (RPOC)
infection (endometritis)
tears and trauma
lochia is
vaginal bleeding postpartum, a mix of blood, endometrial tissue and mucus.
It is normal for 3-4 weeks postpartum and the amount of blood is compared to a period or less
investigations of secondary PPH
US for RPOC
endocervical and high vaginal swabs for endometritis
management of PPH
ABCDE
base on clinical signs not just estimated blood loss
catheterisation to empty bladder (full bladder reduces contractions)
rubbing uterus to stimulate contractions
oxytocin slow IV
ergometrine slow IV
synometrine (mix of oxytocin and ergometrine)
tranexamic acid IV (antifibrinolytic)
carboprost IM
misoprostol rectally
contraindications of ergometrine
hypertension as raises BP
surgical management of PPH
intrauterine balloon tamponade
uterine artery ligation
B lynch suture (around the uterus to compress it)
hysterectomy last resort but will stop bleeding
how long is postnatal period
6 weeks also known as puerperium
support in postnatal period
midwife visits in first 9-10 days at home after that referred to health visitor- for abnormal bleeding, infection, mental health
6 weeks postnatal check at GP discuss contraception and mental health
risk to mothers who have not breastfed
- Breast cancer
- Ovarian cancer
- Hip fractures
- Heart disease
4 Ts of PPH
tone- most common cause is uterine atony (failure to contract after delivery)
trauma- birth canal injury or tear. increased risk in instrumented deliveries
tissue- retained placental or foetal tissue can cause continued bleeding
thrombin- coagulopathies
