OSCE: PPH + Management

What is pph?

500 mls + blood loss after an svd

1000mls after lscs

Or any amount that compromises maternal wb

An obstetric emergency

4 causes

Tone

Trauma

Tissue

Thrombin

risk factors: tone

70%

Uterine atony

Overextended uterus → multipls, poly, macrosomia

Prolonged labour

⬆ medicalised labour + birth → induc, epidural

Risk factors: trauma

20%

Soft tissue → vagina, perineal, cervical tears

Episiotomy

Operative birth

Recognition of PPH

bleeding → obvious or concealed

Concealed → uterus → firm, woman’s condition may deteriorate

Tachycardia, ⬆ rests, hypotension, sweating, ⬇ urine output

Uterine assessment: atonic uterus→ boggy, enlarged

Early recognition !!

What do u do if she looks/ says she doesnt feel well (placenta out)

Baby to the cot IMMEDIATELY

See lots of bleeding: rub up contraction (someone will be constantly doing this)

Call for help: say PPH !!

SOAPS: incl haematologist!!

Someone check placenta to confirm its not tissue

First line management (no meds)

Expel any clots

Keep legs elevated w pillow

Insert catheter to monitor in and out

2 cannulas

Take bloods: fbc group and hold coag cross match u&e

what does emptying the bladder do

Allows for uterus to shrink + not become boggy

Management of PPH: tone

Uterine massage

Uterotonic → oxytocic drugs

Mnemonic for pph

10

10

40

Emc

Txa

What type of fluid would u use and why

Crystalloid: Hartmanns max of 2L

Put in warmer w pressure cuff iv

Replaces blood loss

Has sugar in it

Oxytocin: tone

10 iu im repeat

10 iu iv slowly

40 iu in 500 nacl over 4hrs

Ergometrine: tone

500 mcg iv repeat as needed after 5mins

Side effects: nausea and vomiting

Avoid : HTN and PET

Misoprostol: tone

600mcg subcutaneous

Side effects: shivering and fever

Carboprost: tone

250mcg 15 mins apart

Avoid: Asthma

Max 8 doses

3rd line management

Surgical resus

Bimanual compression

Hdu

More bloods

Management of PPH: tissue

assess placenta

Manual removal if rpoc

Management of PPH: replace

IV access

Urgent bloods → group + screen, fbc, fibrinogen

Start fluid resus

Monitor obs every 15 mins incl. urine output

Secondary PPH

24 hrs + up to 6 was p/n

Usually 10-14 days

Recognition

Heavy/prolonged lochia

Sudden ⬆ in bleeding

Uterus is enlarged and soft

Tachy + Pyrexia → infection

Role of midwife

Early recog + escladizzy

Continuous mat. assessment

Interaction w/ multidisciplinary team

Accurate + timely documentation

Psychological help

Advocacy 4 woman

Role of midwife: prevention

a/n risk assessment → anaemia, prev pph etc.

Active management 3rd stage

Appropriate place of birth for care pathway

Role of midwife: post pph

debriefing

Emotional support, support bonding + bf

Monitor for anaemia