PPH

Question 1

What is a primary postpartum haemorrhage?

Answer 1

Blood loss of >500ml within the first 24 hours of birth.

Question 2

What is a secondary postpartum haemorrhage?

Answer 2

Blood loss of >500mls after the first 24 hours of birth up until 6 weeks postpartum.

Question 3

What dose of IM/IV syntocinion do you administer in a PPH?

Answer 3

10 IU IM into the outer middle thigh or 5 IU IV.

Question 4

What actions should you take in early recognition of a PPH?

Answer 4

• Lie the woman flat (gravity)
• Baby skin to skin (stimulate oxytocin)
• Fundal massage (expel clots)
• Administer 10 IU IM syntocinon (contract uterus)
• Observations (TPR, BP, EBL)
• Empty bladder

Question 5

What are the four T’s for causes of PPH?

Answer 5

Tone, Tissue, Trauma, Thrombin

Question 6

What is tone referring to in a PPH?

Answer 6

Uterine atony (failure of the uterus to contract sufficiently)
- 70% of PPH causes

Question 7

What is tissue referring to in a PPH?

Answer 7

• Retained placenta (not birthed within expected timeframe)
• Membranes not complete/intact = fragments remain inside)
• Placenta accreta (placenta grows too deeply into uterine wall)
• 10% of PPH causes

Question 8

What is trauma referring to in PPH?

Answer 8

• Lacerations to the uterus (C-section)
• Episiotomy
• 20% of PPH causes

Question 9

What is thrombin referring to in PPH?

Answer 9

• Excessive bleeding due to inadequate blood clotting (anticoagulation)
• <1% PPH cause

Question 10

In early recognition of PPH, how would you minimise the impact of blood loss?

Answer 10

• Call obstetrician
• Insert large bore IV cannulation
• Start rapid IV fluids with crystalloids (sodium chloride 0.9%)
• Take blood for FBC, G+H, Coagulation

Question 11

What actions will you take for ongoing bleeding in PPH?

Answer 11

• Administer syntometrine 1ml IM (no more than 3ml in 24hrs)
• Bimanual compression (stop bleeding)
• Oxytocin infusion 40 IU in 500ml sodium chloride 0.9% over 4 hours
• Ask senior obstetrician and midwifery team to attend immediately
• Insert indwelling catheter (empty bladder to prevent it from stopping the uterus from contracting)