PPH Flashcards
(22 cards)
Recite the PPH guideline
How does the guideline define a primary PPH?
Blood loss > 500 mL in the first 24 hours after birth.
Which three features must you assess first?
• Fundus tone
• Visible blood loss
• Perineal/vaginal laceration.
What are the two possible fundal findings that guide care?
Fundus firm vs Fundus not firm.
Describe a ‘firm’ fundus.
Palpable, central and compacted uterus.
What oxygen therapy is recommended when the fundus is firm?
High-flow oxygen.
Which CPG should you consult for analgesia?
CPG A0501 Pain Relief.
For a woman with BP < 90 mmHg and a firm fundus, what is the initial fluid bolus?
Normal Saline up to 40 mL kg⁻¹ IV, titrated to response.
If more fluid is needed but no consult is available, what repeat bolus can you give?
Normal Saline 20 mL kg⁻¹ IV.
How do you manage visible perineal/vaginal lacerations in a firm-fundus scenario?
Apply a dressing and firm pressure.
Why should you avoid fundal massage before the placenta is delivered?
Massage may cause placental separation and worsen bleeding or uterine inversion.
List two general actions that apply to ‘fundus not firm.’
• Manage as per firm fundus items (O₂, fluids, etc.)
• Keep reassessing PV bleeding and vitals.
What hand technique is used to massage the uterus?
Use a cupped hand with firm circular pressure until the uterus becomes firm.
Which two patient-centred actions may help the uterus contract when it’s not firm?
• Encourage the mother to empty her bladder
• Encourage the baby to suckle.
If the fundus remains not firm, what is the first-line uterotonic drug, dose and route?
Oxytocin 10 IU IM.
When can you repeat the Oxytocin dose, and at what dose?
Repeat 10 IU IM after 5 minutes if bleeding continues.
What antifibrinolytic agent is indicated, including dose and administration time?
Tranexamic acid 1 g IV over 10 minutes.
What must never be attempted when the fundus is still not firm, and why?
Do not attempt manual delivery of the placenta due to the risk of uterine inversion.
Define ‘intractable haemorrhage’ management in this CPG.
Proceed to external abdominal aortic compression.
Where exactly is the compression point for abdominal aortic compression?
Just above the umbilicus and slightly to the left.
Describe how to apply abdominal aortic compression.
Apply downward pressure with a closed fist directly through the abdominal wall.
How can you tell if your aortic compression is working?
Check for loss or significant reduction of the palpable femoral pulse while pressure is applied.
