PPH

Question 1

PPH is:
* Excessive bleeding from the genital tract after the birth of the baby to ___ weeks postpartum
* Amount - usually ___mls or any amount however slight that causes a deterioration in maternal condition

Answer 1

6 weeks, 500 mls

Question 2

Primary PPH:
* Blood loss of greater than ___ ml due to vaginal delivery and loss of ___ ml due to ____ within first ____ hours of delivery
* Incidence is _% of all deliveries
Secondary PPH:
* Excessive vaginal blood loss or heavy lochia discharge occurring at least ___ Hours after the end of the third stage of labor

Answer 2

Primary PPH:
* Blood loss of greater than 500 ml due to vaginal delivery and loss of 1000 ml due to C section within first 24 hours of delivery
* Incidence is 5% of all deliveries
Secondary PPH:
* Excessive vaginal blood loss or heavy lochia discharge occurring at least 24 hours after the end of the third stage of labor

Question 3

Causes of PPH (4 Ts):
Tone
Tissue
Trauma
Thrombin
* Most common cause: _____ (Tone)
* _____ of the genital tract (Trauma)
* Uterine surgeries eg ______ (Trauma)
* Uterine _____ (Trauma)
* Retained _____ fragments (Tissue)
* _____ disorders (Thrombin)
* ______ of the vulva, vagina, or
subperitoneal areas (Thrombin)

Answer 3

• Most common cause: uterine atony (Tone)
• Lacerations of the genital tract (Trauma)
• Uterine surgery eg Episiotomy (Trauma)
• Uterine inversion (Trauma)
• Retained placental fragments (Tissue)
• Coagulation disorders (Thrombin)
• Haematomas (bruise) of the vulva, vagina, or
  subperitoneal areas (Thrombin)

Question 4

Signs and Symptoms
* Altered level of _____ (GCS)
* ____ (Colour)
* Thready, rapid, weak ____
* Decreased blood ______
* Relaxed ____
* + Pain at lower abdomen or _______
* Heavy bleeding (lochia) and blood clots per
_____

Answer 4

Signs and Symptoms
* Altered level of consciousness
* Pallor
* Thready, rapid, weak pulse
* Decreased blood pressure
* Relaxed uterus
* + Pain at lower abdomen or perineum
* Heavy bleeding (lochia) and blood clots per
vagina

Question 5

Complicationsof PPH
* _____ due to bleeding
* increased risk of ____
* ____ shock
* Hazards of ______
* Acute _____ failure
* Maternal death

Answer 5

• Anaemia
• increased risk of infection
• Hypovolaemic shock
• Hazards of blood transfusion
• Acute renal failure
• Maternal death

Question 6

Prevent PPH
* Identify high risk groups ___
* Provide good ______
- ____
- correction of predisposing factors, eg ____
* Proper management of first, second and third stage of labour
* For high risk group, ______ on admission

Answer 6

• Identify high risk groups antenatally
• Provide good antenatal care
• diet
• correction of predisposing factors, eg anaemia
• Proper management of first, second and third stage of labour
• For high risk group, GXM blood & set up IV line on admission

Question 7

Principles of Management: primary
 Call for medical aid
 Stop the bleeding
(according to the cause)
 Replace blood if loss is
severe
 Resuscitate the mother

Subsequent care:
* Estimate the_____
* Monitor & record _____
* Assess the condition of the _____
√ Well-contracted; lochia amount
* Fluid replacement - ______
* Monitor _______
* Ensure ______ for recovery
* Document care rendered

Answer 7

Principles of Management: primary
 Call for medical aid
 Stop the bleeding
(according to the cause)
 Replace blood if loss is
severe
 Resuscitate the mother

Subsequent care:
* Estimate the blood loss
* Monitor & record parameters
* Assess the condition of the uterus
√ Well-contracted; lochia amount
* Fluid replacement - do not overload
* Monitor intake & output
* Ensure conducive environment for recovery
* Document care rendered

Question 8

Principles of Managment: Secondary PPH
* Admit patient
* Assess patient’s condition
* Treatment is based on ____
After Care :
- Check patient’s ____
- Educate regarding further bleeding; Iron &
vitamin supplements; high protein diet; s/s of
infection; future pregnancies

Answer 8

Principles of Managment: Secondary PPH
* Admit patient
* Assess patient’s condition
* Treatment is based on cause(s)
After Care :
Check patient’s Full blood Count
Educate regarding further bleeding; Iron &
vitamin supplements; high protein diet; s/s of
infection; future pregnancies

Question 9

General management of PPH:
Nursing management
– Fundal massage
– Pad count (how many & how much are
soaked with lochia)
– Administration of uterotonic (Oxytocin,
Misoprostol)
– Fluid administration
– Monitoring for signs and symptoms of shock
– Emergency measures if DIC occurs

Question 10

Therapeutic managementof PPH
* Focus on underlying ____
* ____ – at patient’s bed side
* Removal of ____ – in the Operating Theatre (OT)
* Repair of ____ – at patient’s bed side/ OT
* _____ to minimise infection as ordered

Answer 10

• Focus on underlying cause
• Uterine massage – at patient’s bed side
• Removal of retained placental fragments – in the
  Operating Theatre (OT)
• Repair of lacerations – at patient’s bed side/ OT
• Antibiotics to minimise infection as ordered