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11 Cards in this Set
- Front
- Back
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Definte post partum haemorrhage?
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> 500mls blood at the time of vaginal delivery or > 1000ml with C/S
Primary - within first 24 hours postpartum Secondary - after 24 h but within first 6 weeks |
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Aetiology of PPH?
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4 Ts
Tone - uterine atony Tissue - retained placental tissue, retained blood clots, gestational trophoblastic neoplasia Trauma - genital tract trauma Thrombin - coagulopathy Think an empty, contracted, intact uterus will not bleed in the absence of coagulopathy |
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What is the most common cause of PPH?
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Uterine atony
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RF for uterine atony?
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Labour (prolonged, precipitous, induced, augmented)
uterus (infection, over-distension) placenta (abruption, previa) maternal factors (grand multiparity, gestational HTN) halothan anaesthesia |
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Management of uterine atony?
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Massage uterus (rub up)
IV ergometrine 0.25mg Fist into uterus to compress Indwelling urinary catheter Resuscitation (large bore IV, group and cross match, coag studies, D-dimer), measure blood loss, commence fluid balance chart |
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How do we avoid uterine atony?
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Give syntocin with delivery of the anterior shoulder
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What kinds of trauma can occur to give rise to PPH?
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Laceration (vagina, cervix, uterus)
Episiotomy Hematoma (vaginal, vulvar, retroperitoneal) Uterine rupture Uterine invasion |
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RF for coagulopathy leading to PPH
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Pre-eclampsia
HELLP Placental abruption Sepsis Bleeding disorders (haemophilia, DIV, aspirin, ITP, TTP, vWD) Sepsis Amniotic fluid embolism |
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Investigations in PPH?
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Assess degree of blood loss and shock by clinical exam
Explore uterus and lower genital tract for evidence of tone, tissue, trauma |
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Conseqeunces of PPH
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Hypovolaemic shock
coagulopathy - DIC anaemia blood transfusion hysterectomy lactation difficulties death |
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How do you manage PPH?
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Check vitals
Cannula - fluids, Uterine massage syntocinon (40mls 250mls per hour) Check for trauma If uterus is tight and no signs of trauma assume retained placenta - theatre |
