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Flashcards in PPH Deck (24):
1

what is primary PPH

loss of >500ml in first 24h after delivery (1L in C section)

2

causes primary

uterine atony, genital tract trauma, clotting disorders

3

risk factors

prev PPH or retained placenta, APH, BMI >35, anaemic, multiparity 4+, maternal age >35, uterine malformation/fibroid, large placental site, low placenta, prolonged labour, induction/oxytocin use, C section

4

what needs to happen to restrict blood flow through uterine vessels

uterine contraction- shortens uterine vessels, retracts placental bed. if doesn't contract then haemorrhage

5

what may happen after placenta delivery leading to a rising fundus

blood may clot inside the uterus and not be expelled

6

management primary

oxytocin 5mu IV. O2. bloods

7

causes of PPH the 4 Ts

Tone, Trauma, Tissue (retained products), Thrombin (coag)

8

who should you alert in PPH

minor- midwife, obs and anaethestics, major- consultants blood transfusion

9

what is third stage bleeding

placenta still in uterus

10

management 3rd stage bleeding

contraction rubbed up, fundal pressure with cord traction try and deliver placenta. if cant be delivered- uterine exploration.

11

what is a true PPH

placenta has been expelled

12

management true PPH

massage uterus, Hartmanns, ergometrine IV or syntocinon (oxytocin), syntometrine , misoprostol

13

if PPH is severe what can you give

carboprost- directly into myometrium or deep IM

14

what is contraindicated in hypertension

syntometrine

15

when is transfusion needed

if >1000ml

16

if bleeding continues with the treatment what can you give

oxytocin 10units in 500ml dextrose

17

further steps in PPH after medical treatment

bimanual pressure, tranexamic acid, explore uterus for rupture.

18

surgical treatments PPH

hysterectomy, uterine packing, vessel ligation (internal iliac or uterine ). B lynch brace uterine suture

19

use of what drug in 3rd stage labour reduces rates primary PPH

oxytocin

20

what is secondary PPH

excessive blood loss from the genital tract after 24h from delivery (usually 5-12 days)

21

what is secondary PPH due to

retained placental tissue or clot. endometritis

22

what can occur in secondary PPH

infection

23

when is exploration necessary in secondary PPH

heavies blood loss, retained product in US, tender uterus, open os

24

management secondary PPH

cross match blood. pre op antibios. curette the uterus