PPH

Question 1

What is primary PPH

Answer 1

Loss of >500ml in the first 24h after delivery

Question 2

What are the causes of primary PPH (4 T’s)

Answer 2

Tone - uterine atony (90%)
Tissue - retained products of conception
Trauma - genital tract trauma
Thrombin - clotting disorders

Question 3

What is massive haemorrhage

Answer 3

loss of >1500ml

Question 4

What is secondary PPH

Answer 4

XS blood loss from the genital tract after 24hr from delivery

Question 5

When does secondary haemorrhage tend to occur

Answer 5

5-12 days

Question 6

What is the usual cause of secondary pph

Answer 6

retained placental tissue or clot, often w infection

Question 7

What is rx of secondary pph

Answer 7

abx, US to look for retained products

Question 8

What are antenatal RF for primary PPH

Answer 8

prev PPH
prolonged labour 
pre-eclampsia
increased maternal age 
polyhydramnios
emergency CS
placenta praaevia/accreta
macrosomia
ritodrine (tocolytic)

Question 9

What are RF for primary PPH IN labour

Answer 9

prolonged labour
induction or oxytocin use
precipitate labour (rapid)
operative birth or CS

Question 10

Give treatment regimen for PPH

Answer 10

1. ABC
2. deliver placenta, empty uterus of clots or retained tissue
3. massage uterus/bimanual compression (generate contractions)
4. drugs
5. Rusch balloon, B-lynch suture or ligation of uterine or internal iliac arteries
6. hysterectomy

Question 11

What drugs are used in pph

Answer 11

− IV Syntometrine (oxytocin + ergometrine)
− Misoprostol
− Carboprost IM

Question 12

When is hysterectomy indicated in PPH

Answer 12

Last resort - if severe uncontrollable bleeding