Postpartum Haemorrhage

Question 0

Classification

Answer 0

Primary - within 24 hours

Secondary - from birth to 6 weeks post partum

Question 1

Definition of PPH

Answer 1

> 500 ml after NVD

>1L blood loss after C/S

Question 2

Risk factors of PPH

5

Answer 2

Previous PPH
previous c/s
Parity >5
Atonic uterus
Poor management of 3rd stage 
Assisted deliveries
APH
Preeclampsia 
Multiple pregnancy
Obesity
Chorioamnionitis
Chronic diseases and ARVs

Question 3

Avoidable factors with PPH

X4

Answer 3

Delay in seeking help
Delay in transport
No attendance
Lack of specific health facilities
Lack of sufficient blood
Inadequate monitoring
Lack of sufficient staff

Question 4

Causes for PPH

4 x T

Answer 4

Tone (atonic uterus)
Tissue (retained products of conception)
Trauma (genital tract trauma, inverted uterus, ruptured uterus)
Thrombin (coagulopathies)

Question 5

Prevention of PPH

X8

Answer 5

Detection of risk
Detection and treatment of anaemia
Deliver at appropriate level 
Active management of 3rd stage
Prevent prolonged labour
Be careful with use of oxytocin and misoprostal in multigravid women (rupture)
Early latching
MONITOR

Question 6

Management of PPH

X7

Answer 6

IV access by 2 large bore IVs
Send off blood (FBC, clotting screen, cross match)
Catheterise and hourly urine output
Rub up uterus
Infuse oxytocin (20units in 1L ringers)
Give O2
If placenta is undelivered, manually evacuate

Question 7

Active management of PPH

Answer 7

Massage uterus
Continue oxytocin infusion
IV ergometrine 0.5mg or repeat 1amp oxytocin
Misoprostal 400-600 microgram
Prostaglandin factor 2 alpha 5mg in 10ml saline into myometrium
Balloon tamponade