Postpartum haemorrhage

Question 1

what is it defined as?

Answer 1

blood loss of > 500 ml after a vaginal delivery and may be primary or secondary.

Question 2

2 types

Answer 2

primary

secondary

Question 3

when does primary PPH occur?

Answer 3

Primary PPH occurs within 24 hours.

Question 4

causes of PPH 4Ts

Answer 4

Tone (uterine atony): the vast majority of cases
Trauma (e.g. perineal tear)
Tissue (retained placenta)
Thrombin (e.g. clotting/bleeding disorder)

Question 5

risk factors of primary PPH

Answer 5

previous PPH

prolonged labour

pre-eclampsia

increased maternal age

polyhydramnios

emergency Caesarean section

placenta praevia, placenta accreta

macrosomia

the effect of parity on the risk of PPH is complicated.

It was previously thought multiparity was a risk factor but more modern studies suggest nulliparity is actually a risk factor

Question 6

Mx

Answer 6

LIFE THREATENING

A-E

Mechanical
- palpate uterine fungus and rub it to stimulate contractions
- catheterise

Medical
-IV oxytocin
- IV/IM ergometrine
- IM carboprost
- misoprostol sublingual
- tranexamic acid

Surgical
- if medical options fail
- intrauterine balloon tamponade

Question 7

when does secondary pph occur and why?

Answer 7

between 24 hours - 6 weeks. It is typically due to retained placental tissue or endometritis.