PPH

Question 1

What is PPH

Answer 1

1. Loss of 500 mL of more from vag delivery
2. Loss of 1000 mL or more from cesarean
3. Blood loss that causes hemodynamic instability

Question 2

Primary PPH

Answer 2

First 24 hours after delivery

- #1 cause is uterine atony

Question 3

Secondary PPH

Answer 3

From 24 hours to 12 weeks after delivery

- #1 cause of this is delayed subinvolution of uterus

Question 4

4 Ts of PPH

Answer 4

1. Uterine atony (most common)
2. Trauma to birth canal
3. Retention of fetal or placental tissue
4. Coagulopathy or thrombin disorder

Question 5

Risk Factors for PPH

Answer 5

• Prolonged labor
• Grandmultipara (given birth 5+ times)
• Augmented labor
• Precipitated labor (less than 3 hours)
• History of PPH
• Overdistended uterus
• Operative delivery
• Chorio

Question 6

Third stage hemorrhage

Answer 6

Occurs before expulsion of placenta

Question 7

What causes uterine atony?

Answer 7

• Overdistension of uterus
• Uterine muscle exhaustion from prolonged labor
• Uterine infection
• Uterine relaxants
• Retained placental fragments

Question 8

What causes subinvolution of uterus?

Answer 8

• Retained products/tissue of conception

- Infection

Question 9

How to manage PPH

Answer 9

1. Stop the bleeding by massaging vigorously and GET HELP
2. Run pitocin (usually 20 units IV or can do IM)
3. Give methergine (unless HTN) or hemabate (unless asthma) or cytotec
4. Q5 min vitals
5. Measure urine output (strict I and O)