PPH Flashcards Preview

Jason's MD3 Women's > PPH > Flashcards

Flashcards in PPH Deck (35):
1

Signs of placenta separation

Lengthening of the cord
Show of blood

2

Why not deliver placenta before it's separated?

Might invert uterus
Vaso vagal shock, hypotension, maternal death

3

Oxytocics available?

Syntocinon 10 units IV
Ergometrine 0.25mg IV
Syntometrine IM

4

How long placenta delivered 'naturally'?

An hour

5

Why active management of 3rd stage?

Reduce PPH

6

Technique to active management

Controlled cord traction

7

Do you press on uterus after syntocinon?

Nope. Let it be, watch for cord lengthening

8

Primary PPH?

Within 24 hours more than 500ml

9

Secondary PPH?

After 24 hours Up to 6 weeks, excessive amount of loss

10

Commonest cause of PPH?

Uterine atony (70%)

11

Why must uterus contract in 3rd stage

Controlled PPH via uterine muscle contraction

12

Causes Uterine atony?

Polyhydramnios
Multiple pregnancy
Macrosomia
Mass - fibroids
PROLONGED LABOUR

13

Causes of PPH via trauma 20%

episiotomy, tear in perineum
Vaginal tear
Cervical tear
Uterine rupture

14

Uterine rupture tends not to occur in?

Primigravid

15

PPH other causes

retained products
Coagolopathy

16

Coagulopathies around the time of delivery? 1% of time.

Preeclampsia
Eclampsia
DIC
Placenta abruption
Amniotic fluid embolism

17

% of PPH

70% uterine atony
20% - trauma
9% - retained products
1% - coagulapathy

18

Pre delivery causes of coagulopathies

Von willebrands
Throbocytopaenia

19

How much blood loss you need before transfusion?

1500 mL, EVEN if pulse and BP is ok.

20

If PPH and bleeding, given syntocinon, still bleeding what to do?

Give ergometrine
Rub the uterus
Look for tears - usu. venous pressure
Take bloods for coags

21

Don't forget to put in what to help uterine contraction?

Urinary catheter to empty the bladder

22

If lose 1500mL, then what?

Give transfusion
Take her to theatre!!
-check for inversion, rupture, products
PGF2alpha

23

If after surgical exploration after losing 1500mL and still not control?

-Balloon catheter 500mL for 24 hr. ABx.
-Ligation of the uterine arteries/internal iliac arteries
-laparotomy, hysterectomy for survival

24

If someone has preeclampsia, how to manage PPH?

Try to avoid ergometrine

25

If PPH from coag disorder, how to manage?

Balloon catheter
Then give coags, FFP, platelets

26

Causes of secondary PPH

Infection
Retained products

27

secondary PPH Management?

FBE, CRP
ABx

28

Signs of secondary PPH Infection?

Febrile
Tender uterus

29

secondary PPH Speculum?

Look for discharge
Cervix likely to be open
TAKE SWABS

30

ABx for secondary PPH?

Penicillin
Metronidozole
If over 39 degrees: Gentamicin
All IV

31

secondary PPH For retained products management?

U/S
Hysteroscopy D&C

32

Risk of using sharp curette for retained products?

Ashermann's syndrome

33

Risk of VBAC for uterine rupture?

1 in 200

34

Risk of VBAC of uterine rupture with augmentation?

1 in 100, up to 1 in 25

35

If not delivered placenta by 1 hour what to do?

Take them to theatre for manual removal