Postpartum Hemorrhage (PPH)

definition postpartum hemorrhage

loss >500ml blood after vaginal delivery OR >1000ml blood after c-section

decrease Htc by 10% or need for blood transfusion

immediate vs late PPH

immediate - within first 24h after childbirth

late - >24h

predispoing factors PPH from vaginal delivery

• prolonged third stage labour (>30m)

• preeclampsia

• mediolat episiotomy

• twin pregnancy

predispoing factors PPH from c section

• general anesthesia

• chorioamnionitis

• preeclampsia

  • prolonged second stage labour

presentation late PPH

>24h after delivery w/ soft uterus - variable bleeding, foul-smell, anemia

immediate PPH w/ soft uterus and signs of shock means what dg

uterine atony

presentation of uterine rupture

immediate PPH w/ severe abd pain, signs shock, acute abd, tachy

general preventine measures for PPH

anticiptating risk in patients w/ preeclampsia, twin pregnancy, chorioamnionitis

blood group and Rh

IV access

active preventive management in 3rd stage of labour of PPH

• uterotonic (oxytocin or ergometrine) administration after delivery fetus

• manual detachment and extraction of placenta

• uterine massage

COs to ergometrine (uterotonic)

pre/eclampsia, pre-existing htn

what to look for in maternal soft tissue exam to prevent PPH

• cervical tear

• vaginal lacerations

• extension episiotomy

causes PPH

• uterine atony

• retained conception products

• injuries to maternal soft tissues, uterine rupture, inversion

Bumm maneuver

intrumental uterine exam to check for retained placental fragments

_____ placenta is a cause of PPH and is associated w/ premature births

adherent

risk factors uterine rupture

uterine scar

augmentation of labour

multiparity

in __________ that cause PPH, shock symptoms are more pronounced than blood loss, and results from forcing delivery of an adherent placents

uterine inversion

DIC causing PPH - risk factors

molar pregnancy

amniotic fluid embolism

retained intrauterine dead fetus

_____ is An autosomal recessive disorder that leads to a relative deficiency of factor VIII

von Willebrand

HELLP sd, autoimmune thrombocytopenic purpupra are what types of coag disorders (that can cause PPH)

thrombocytopathies

ttt uterine hypotonia causing PPH

• uterine massage

• oxytocin/ergometrine

• if persists - re-examine, coag status, apply bimanual uterine and abd aortic compression

• if persists - laparotomy → subtotal hysterectomy

retained placenta causing a PPH - ttt if placenta not delivered or cotyledon segments missing within 30m

manual extraction

what signs mean that a PPH is major

pulse >100bpm

systolic bp <100mmHg

blood loss >1500ml

immediate inital measures PPH

O2 via face mask

establish IV access, monitor pulse and BP

assess Tone, Tissue, Trauma, Thrombin