6.1 G) I) Obstetrics And Gynaecology Postpartum Haemorrhage (Cameron)

Front 1

What are the 4 T's of Post Partum

haemorrhage (PPH) ?

Back 1

1. Tone : Atonic uterus **
2. Trauma : Uterine rupture / inversion
3. Tissue : Retained placenta
4. Thrombin : Coagulopathy

Front 2

Which is incorrect regarding PPH?

A. It is the most common cause of direct perinatal Maternal Death.
B. Atonic uterus is the most common cause of PPH.
C. Traditional definition = > 1000mL in first 24 hours after delivery.
D. Loss of > 150mL /min = "Massive Obstetric haemorrhage"

Back 2

C. PPH =

> 500mL in 24 hours post vaginal delivery

> 1000mL after Caesarian section.

Front 3

List the Risk Factors for PPH.

Back 3

1. Previous PPH
2. Abnormal uterus ( infection ; fibroids )
3. Multiple pregnancies
4. Large Baby / multiple pregnancy ( multifetal gestation)
5. Labour abnormalities : precipitous / prolonged
6. Coagulopathy ( many causes)
7. Polyhydramnios
8. Previous Caesarian section
9. Forceps / Operative Delivery

Front 4

List the Causes for Coagulopathy, leading to PPH.

Back 4

1. Pre-eclampsia / HELLP
2. Placental abruption
3. Drugs
4. Sepsis
5. Amniotic fluid embolism

Front 5

What are the main Medical-Pharmacological Mx options for treatment of PPH?

Back 5

1. Oxytocin
- ** 40 units in 1000mL saline over 4 hours (titrate 250-500mL/Hr to sustain uterine

contractions and control haemorrhage)
- 10 units IMI if no access
2. Ergometrine 250 ug IV / IMI (Ergot alkaloid)
3. Misoprostol 1000ug PR (Prostaglandin )

Front 6

What are the sequential Non-Pharmacological Management options for PPH?

Back 6

1. Fundal massage
2. Ensure placental delivery whole
3. Bimanual uterine compression (temporising pre-OT)
4. Uterine tamponade (Bakri Balloon / Sengstaken-Blakemore Tube )
5. Uterine artery ligation
6. Internal iliac artery ligation
7. Uterine compression sutures
8. Hysterectomy: operation of last resort.

Front 7

Which is incorrect regarding secondary PPH?

A. Ergometrine is given 500ug IV / IMI
B. Broad spectrum Antibiotics are required
C. It is either due to infection or retained

products
D. There is usually no abdominal pain.

Back 7

D. Incorrect

Characterised by pain / bleeding / discharge and fevers.

Front 8

( ED MCQ Book 2012 )
What is the difference between Primary and

Secondary PPH ?

Back 8

Primary : Bleeding within 24hours post delivery

Secondary : Bleeding after 24 hours post

delivery

Primary : Uterine atony > 80% cases

Secondary : Retained products or infection.

Front 9

Tintinalli

list the 6 main causes of Primary Postpartum haemorrhage.

Back 9

1. Uterine atony

2. Uterine rupture

3. Uterine inversion

4. Retained placental fragments

5. Lower genital tract lacerations

6. Hereditary coagulopathy

Front 10

Tintinalli

which of the following is incorrect regarding

PPH ?

A. It is the most common cause of maternal mortality worldwide.

B. Uterine inversion is caused by overzealous attempts at placental

removal.

C. Multifoetal gestation and macrosomia can cause uterine atony.

D. Secondary PPH can occur for up to 2 weeks post partum.

Back 10

D. Secondary PPH can occur up to Up to 6 weeks post partum.

Front 11

Tintinalli

In regards to Uterine rupture, which of the

following is incorrect ?

A. The risk is ten times higher in the scarred uterus.

B. Caesarian section is the primary risk factor.

C. The rate is 0.1%

D. The rate of intrapartum uterine rupture

secondary to previous caesarian section is 0.2 to 0.8%.

Back 11

C. The rate of uterine rupture is 0.01%

Front 12

Tintinalli

List the Risk factors associated with uterine

rupture.

Back 12

1. Scarred Uterus

( previous Caesarian section)

2. Malpresentation

3. Labour dystocia

4. Hypertensive disorders

5. Bicornate uterus

6. Grand multiparity

7. Connective Tissue disorders

8. Abnormal placentation