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Obstetrics > PPH > Flashcards

Flashcards in PPH Deck (9)
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1
Q

Major causes of PPH?

A

1- atonic uterus
2- retained placenta or fragment of placenta
3- trauma - vaginal lacerations cervical and perineal tears ruptured uterus
4- bleeding dur to c section
5- uterine inversion rare

2
Q

What can you do to prevent PPH?

A

Iron supp during pregancy to protect vs anaemia.
At risk women -aph -grandmulti - previous pph -multi preg -prolonged labour) must deliver in level 1 2 hospital.
Prevent prolonged labour
Active manage 3rd stage
Post partum vital manage

3
Q

How to prepare staff for pph?

A

Posters in labour wards
Enough iv infusion sets and fluids
Eniugh drugs ans equip
Drills and skills training

4
Q

What to do to stop bleeding?

Placenta delivered

A

Do first two steps despite cause!!

1- rub up uterus
2- iv infus 20u of oxytocin in 1ltr fluid.
3- empty bladder as it may cause poor uterine contraction
If atonic still give 0.5mg ergometrine IM unless hpt or cardiac issues… In this case give 400-600mcg of misoprostal
4- suture any bleeding tears

5
Q

What to do to stop bleeding?

Placenta Undelivered

A
Pv- remove if in os
Manual removal under anaesthesia 
Iv oxytocin 20in 1ltr
Antibiotics
Place in high care for recovery
6
Q

In pph what to do immesiately?

A

Help
Dont leave pt
2 large iv + fluids

7
Q

What to do in persitant bleeding?

A

1- review initial dx of bleeding. Suspect coagulopathy secondary to massive hge
2- cross match extra blood or order fresh frozen plasma

Theatre
Additional uterotonic drugs for uterine contraction - ergometrine…
Suture tears
Uterine tamponade with rusch catheter
Examine cavity under anaethesia
Laparotomy - uterine comoression b lynch or uterine artery ligation

8
Q

What happens if they cannot arrest bleeding in theatre?

A

Emergency hystorectomy

9
Q

What amount of blood loss as a result of NVD or C-Section is PPH?

A

NVD >500mls

Csection >1000mls