PPH

Question 1

PPT.

Answer 1

➢ Greater than 500cc blood loss (vaginal delivery) OR
1000cc blood loss (Cesarean delivery)
➢ Decrease in HCT value ≥ 10 %.
(( Blood loss >1000 mL or bleeding accompanied by signs/symptoms of hypovolemia )):
• ↓ blood pressure (BP) and urine output
• ↑ pulse and respiratory rate
• pallor, dizziness, or altered mental status

Question 2

The type of PPH

Answer 2

Early > less than 24 hours post delivery.
Late > over 24 hours post delivery.

Question 3

RISK FACTORS FOR POSTPARTUM HAEMORRHAGE
12

Answer 3

•Uterine over-distension;
•Multipara
•Anaemia
•APH
•Condition of high blood pressure
•Previous postpartum haemorrhage
•Previous retained placenta
•Prolonged labour
•Induction of labour
•Obesity
•Genital tract trauma
•Maternal bleeding disorders

Question 4

Causes of pph 4 Ts

Answer 4

1. Tone
2. Tissue
3. Trauma
4. Thrombin

Question 5

Causes of Tone (MC) 7

Answer 5

1. Previous PPH
2. Prolonged labour
3. Age > 40 years
4. Big baby
5. Multiple pregnancy
6. Placenta praevia
7. Obesity

Question 6

Causes of tissue 3

Answer 6

1. Retained placenta
2. Membrane
3. clot

Question 7

The causes of trauma

Answer 7

1. Caesarean section (emergency > elective).
2. Perineal trauma.
3. Operative delivery.
4. Vaginal and cervical tears.
5. Uterine rupture.

Question 8

Causes of Thrombin

Answer 8

1. Abruption
2. PET
3. Pyrexia
4. Intrauterine death
5. Amniotic fluid embolism
   > Disseminated intravascular
   coagulation DIC.

Question 9

CLINICAL FEATURES PPH 6

Answer 9

○ Uncontrolled vaginal bleeding.
○ Decreased blood pressure.
○ Increased heart rate (tachycardia)
○ Bleeding can be concealed
○ Bradycardia can be present
○ Swelling and pain in tissues in the vaginal and perineal area.

Question 10

MEASURING BLOOD LOSS IN PPH

Answer 10

BRASSS-V DRAPE

Question 11

ACTIVE MANAGEMENT THIRD STAGE LABOR (AMTSL)

Answer 11

• Oxytocin 10 units IM (or in IV solution)
1. With, or soon after delivery
2. More effective than misoprostol
• Continuous, controlled cord traction 1. Delayed cord clamping for 1 to 3 minutes does not increase risk of PPH or adverse neonatal outcomes
2. Use Brandt maneuver
• Transabdominal uterine massage after placenta delivers

Question 12

Before treatment you can check for the three things what is it?

Answer 12

○ Is the uterus well-contracted?
○ Has the placenta been delivered and is it complete?
○ Is the bleeding due to trauma?

Question 13

PPH INITIAL MANAGEMENT :

Answer 13

○ Identification of the severity of haemorrhage
○ Asking for help
○ Communication and multidisciplinary care
○ Resuscitation (( 2 iv acsses 14 gage canula )).

Question 14

Measures for minor PPH (blood loss 500–1000 ml) without clinical shock
What’s the management?

Answer 14

○ intravenous access (one 14-gauge cannula)
○ urgent venepuncture (20 ml) for: – group and screen
– full blood count
– coagulation screen, including fibrinogen.
○ pulse, respiratory rate and blood pressure recording every 15 minutes
○ commence warmed crystalloid infusion