bleed

Question 1

What are the two types of bleeding?

Answer 1

antepartum haemmorage
postpartum heamorage

Question 2

what is aph ?

Answer 2

vaginal bleeding
strictly bleeding from 24w to birth

Question 3

what can aph lead to in the first trimester

Answer 3

can lead to miscarriage, ectopic preg and molar preg

Question 4

what can aph be due to in the third trimester

Answer 4

• plcaenta preva
• placental abruption
• vasa previa

Question 5

what is pph? types?

Answer 5

severe or excessive bleeding after childbirth
1’- < 24hrs
2’- 24h- 6w
of the baby delivery not the placenta delivery !!

Question 6

what is a minor aph bleed

Answer 6

<50ml

Question 7

what is a major aph bleed

Answer 7

50-1000 mL

Question 8

what is a minor pph bleed

Answer 8

500-1000mL

Question 9

what is a moderate pph bleed

Answer 9

1000-2000 mL

Question 10

what is a severe pph bleed

Answer 10

2000mL

Question 11

what are the rf for pph

Answer 11

twins
uterine fibroid
multiparty
recent bleeding Hx
aph
Polyhydramnios ( excess aminotic fluid)

Question 12

what are the causes of bleeds

Answer 12

tone ( mc) ( atonic)
tissue - retained tissue
thrombin- DIC
trauma- perineal tears, uterine rupture

Question 13

why does tone cause bleeds

Answer 13

decreased pressure on spinal arterioles therefore more dilation and blood filling - causing bleeding
( long labour)

Question 14

what is atony

Answer 14

a lack of muscle tone or energy, especially in a contractile organ like the uterus, leading to muscular weakness and an inability to contract properly

Question 15

how to treat atony

Answer 15

fundal massage and empty bladder- catheterise
2x 14g large bore cannula for iv fluid and tranfussions- after group and save
iv oxytocin ( inject then infuse) then iv ergometrine
if fails- surgical

Question 16

what is the surgical treatment for atony/bleeds

Answer 16

intrauterine balloon tamponade!!
then blynch sutures and uterine artery embolization/ligation

Question 17

if major pph what do you do?

Answer 17

ABCDE
1st- call for help
2- cross match group+ save and have blood transfusion ready

Question 18

what are complications of bleeding?

Answer 18

sheehan syndrome - hypopituitirism due to ischemic necrosis of ant pit in massive pph

Question 19

sx of sheehan syndrome

Answer 19

• 2’ amennorrhea,
• agalactorrhea,
• decreased T4,
• Premature ovarian failure
• DIC
• shock- death

Question 20

if there is retained tissue what do you do?

Answer 20

surgical D + C