Postpartum haemorrhage (Complete) Flashcards
(13 cards)
Define postpartum haemorrhage (PPH)
Loss of >500ml blood within first 24 hours of pregnancy
What are the two main types of PPH?
Primary PPH: Occurs within first 24 hours
Secondary PPH: Occurs between 24 hours - 6 weeks
List the causes of PPH
4 T’s:
Tone
- Uterine atony
Trauma
- Birth canal injury
- Intsrumental delivery
Tissue
- Retained placental or foetal tissue
Thrombin
- Coagulopathies
What is the most common cause of primary PPH?
Uterine atony
What is the most common cause of secondary PPH?
Retained placental tissue and infection
What risk factors are associated with PPH?
Antenatal factors:
Advanced age
High BMI
Multiple pregnancy (e.g. twins)
Multiparous
Placental conditions
Hypertensive disorders
Anaemia
Intrapartum:
C-section
Induction of labour
Instrumental delivery
Prolonged delivery
Macrosomia
Tocolytics
Magnesium sulfate
What investigations should be conducted in woman with PPH?
Bedside:
Basic obs: Check haemodynmic status
Endocervical/high vaginal swabs: Check for infection
Bloods:
FBC: Check anaemia
G&S and cross-matching: For blood transfusion
Clotting studies: Check for coagulopathy
U&Es: Check renal function
Imaging:
Ultrasound: Check for retained products
How are woman with PPH managed?
Initial management:
1) A-E approach + consider major haemorrhage protocol
2) Lay woman flat
3) Give oxygen
4) Insert 2 large bore canullas
5) Consider FFP if clotting abnormalities present
Further management:
Mechanical measures:
- Uterine rubbing
- Catheterisation
Medicine:
- Oxytocin
- Syntocinon
- Ergometrine
- Carboprost
- Misoprostol
- Tranexamic acid
Surgical:
- Intrauterine balloon tamponade (first-line)
- B-lynch suture
- Uterine artery ligation
- Hysterectomy (In life-threatening cases and as last resort)
What mechanical measures can be taken in management of PPH?
Rubbing the uterus (to stimulate uterine contractions)
Catheterisation (prevent bladder distension and monitor urine output)
What medication is given in management of PPH?
Slow IV oxytocin
Slow IV ergometrine (unless Hx of hypertension)
Carboprost IM (unless Hx of asthma)
Sublingual misoprostol
Tranexamic acid
What is the first-line surgical management of PPH if medical options have failed?
Intrauterine balloon tamponade
First-line mainly for women where uterine atony is the only or main cause of haemorrhage
What surgical option if required if severe, uncontrollable haemorrhage has occured?
Hysterectomy
What complications can occur due to PPH?
Immediate: (Within hours)
Death
DIC
Hysterectomy
Renal failure
Early: (Within days):
VTE
Long-term:
Sheehan’s syndrome
