Flashcards in PPH Deck (35):
Signs of placenta separation
Lengthening of the cord
Show of blood
Why not deliver placenta before it's separated?
Might invert uterus
Vaso vagal shock, hypotension, maternal death
Syntocinon 10 units IV
Ergometrine 0.25mg IV
How long placenta delivered 'naturally'?
Why active management of 3rd stage?
Technique to active management
Controlled cord traction
Do you press on uterus after syntocinon?
Nope. Let it be, watch for cord lengthening
Within 24 hours more than 500ml
After 24 hours Up to 6 weeks, excessive amount of loss
Commonest cause of PPH?
Uterine atony (70%)
Why must uterus contract in 3rd stage
Controlled PPH via uterine muscle contraction
Causes Uterine atony?
Mass - fibroids
Causes of PPH via trauma 20%
episiotomy, tear in perineum
Uterine rupture tends not to occur in?
PPH other causes
Coagulopathies around the time of delivery? 1% of time.
Amniotic fluid embolism
% of PPH
70% uterine atony
20% - trauma
9% - retained products
1% - coagulapathy
Pre delivery causes of coagulopathies
How much blood loss you need before transfusion?
1500 mL, EVEN if pulse and BP is ok.
If PPH and bleeding, given syntocinon, still bleeding what to do?
Rub the uterus
Look for tears - usu. venous pressure
Take bloods for coags
Don't forget to put in what to help uterine contraction?
Urinary catheter to empty the bladder
If lose 1500mL, then what?
Take her to theatre!!
-check for inversion, rupture, products
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
If someone has preeclampsia, how to manage PPH?
Try to avoid ergometrine
If PPH from coag disorder, how to manage?
Then give coags, FFP, platelets
Causes of secondary PPH
secondary PPH Management?
Signs of secondary PPH Infection?
secondary PPH Speculum?
Look for discharge
Cervix likely to be open
ABx for secondary PPH?
If over 39 degrees: Gentamicin
secondary PPH For retained products management?
Risk of using sharp curette for retained products?
Risk of VBAC for uterine rupture?
1 in 200
Risk of VBAC of uterine rupture with augmentation?
1 in 100, up to 1 in 25