PPH Flashcards
(18 cards)
What is PPH?
Bleeding after delivery of baby & placenta and is the most common cause of significant obstetric haemorrhage
What makes you classify it as a PPH?
500ml after a vaginal delivery
1000ml after C section
What is minor PPH vs major PPH?
Minor PPH = under 1000ml blood loss
Major PPH = over 1000ml blood loss
How do you sub classify major PPH?
Moderate PPH = 1000-2000ml blood loss
Severe PPH = over 2000ml blood loss
What is primary & secondary PPH?
Primary = bleeding within 24 hours of birth
Secondary = from 24 hours to 12 weeks after birth
What are the 4 causes of PPH?
T - tone (uterine atony)
T - trauma (perineal tear)
T - tissue (perineal tears, retained placenta)
T - thrombin (bleeding disorder)
What are the risk factors for PPH?
Previous PPH
Multiple pregnancy
macrosomia
Failure to progress in second stage and prolonged third stage
Pre-eclampsia
Placenta issues
Instrumental delivery
Episiotomy or perineal tear
What preventative measures can you do?
Treating anaemia during antenatal period
Giving birth with an empty bladder
Active management of third stage (IM oxytocin + cord traction)
IV tranexamic acid during C section in high risk pts
How do you manage a PPH?
Resuscitation with ABCDE approach
Lie woman flat, warm and communicate
Two large bone cannulas & take bloods for FBC, U&Es & clotting screen
Group & cross match 4 units
Warmed IV fluid and blood resuscitation as required
Oxygen (regardless of sats)
How do you manage a severe case of PPH?
Major haemorrhage protocol which gives rapid access to 4 units of crossmatched or 0 negative blood
What are the treatment options to stop the bleeding?
Mechanical
Medical
Surgical
What are mechanical treatment options?
Rubbing the uterus through the abdomen to stimulate a uterine contraction
Catheterisation - prevents bladder distension and monitor urine output
What are medical treatment options?
IV Oxytocin
Ergometrine slow IV or IM (contraindicated in hypertension)
Carboprost IM (prostaglandin analogue which is contraindicated in asthma)
Misoprostol (prostaglandin analogue)
Tranexamic acid (antifibrinolytic)
What are surgical treatment options?
Intrauterine balloon tamponade - inserting an inflatable balloon into uterus to press against the bleeding
B Lynch suture - suture around uterus to compress it
Uterine artery ligation
Hysterectomy - if severe, uncontrolled haemorrhage
What are the causes of secondary PPH?
Retained products of conception (placental tissue) or infection (endometritis)
What are the investigations for secondary PPH?
USS for retained of conception
Endocervical and high vaginal swabs for infection
What is the management of secondary PPH?
Surgical evaluation
Antibiotics for infection
