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16 Cards in this Set
- Front
- Back
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What are the risk factors for uterine atony (the most common cause of PPH)
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Overworked
- Rapid labour - Prolonged labour Infected - Chorioamnionitis Relaxed - MgSO4 - Beta adrenergic agonists - Halothane Overdistended - Multiple pregnancy - Polyhydramnios - Macrosomia |
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PPH +
Doughy soft uterus, enlarged above the umbilicus |
Uterine atony
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Management of PPH caused by uterine atony
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Summon senior help, ABC
1) Uterine massage 2) Uterotonics: Oxytocin, ergometrine, prostaglandin F2alpha (heamabate) or misoprostol 3) Catheterise bladder (aids contractions) 3) B-Lynch suture |
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Bleeding in the presence of a contracted uterus with no retained produceds of conception (2nd most cause of PPH)
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Genital tears
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What are the risk factors of PPH due to retained placenta (3rd most common cause of PPH)
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- Accessory lobe
- Placenta accreta |
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PPH + contracted uterus + missing cotyledons
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Retained placenta
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Management of retained products of conception
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Summon senior help, ABC
- Manual removal - Curettage under ultrasound (Hunter's Curette)PP |
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Risk factors of PPH due to DIC (rare)
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- ABRUPTION
- Severe pre-eclampsia - Amniotic fluid embolus - Demise (prolonged retention of a dead fetus) |
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PPH + generalised oozing (excessive bleeding where clotting would have been expected, petechiae rash, contracted uterus
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DIC
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Management of PPH due to DIC
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Summon senor help, ABC
- Romove products of conception - ITU - Blood - Correction of clotting factors using fresh frozen plasma, platelets & cryoprecipitate |
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PPH with non-palpable uterus, Beefy bleeding mass, hx of myometrial weakness
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Inverted uterus
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Management of PPH due to a inverted uterus
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- Replace uterus to it natural anatomical position: elevate vaginal fornices
- Then IV oxytocin (to contract uterus) |
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How do you manage an unexplained PPH?
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Uterine tamponade using uterine ballons, radiological occlusion of uterine vessels, internal illiac vessels, uterine compression sutures hysterectomy
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Sheehan syndrome:
Cause? Lead to? 1st symptom? Hormones affected? |
a) PPH, ischaemia of the anterior pituitary
b) Anterior pituitary insufficiency c) Lactation failure d) Prolactine (then FSH/LH, then (rare) TSH/ACTH) |
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What is primary PPH?
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Loss of >500mL Blood from the genital tract within 24hrs of delivery
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What is the definition of secondary PPH?
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Loss of >500mL Blood from the genital tract between 24hr & 12weeks post delivery
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