Postpartum Hemorrhage Overview

Flashcards covering key concepts and definitions related to postpartum hemorrhage (PPH) for exam preparation.

Postpartum Hemorrhage (PPH)

Defined as blood loss > 500 ml after vaginal delivery and > 1000 ml after cesarean section.

Primary PPH

Occurs within 24 hours of delivery.

Secondary PPH

Occurs after 24 hours up to 12 weeks postpartum.

Minor PPH

Blood loss between 500–1000 mL, usually tolerated well.

Massive PPH

Blood loss > 1000 mL, requires immediate protocol-based management.

Risk Factors for PPH - Maternal

Include advanced maternal age, grand multiparity, obesity, previous cesarean, uterine fibroid, antepartum hemorrhage, and prior PPH.

Intrapartum Risk Factors

Include prolonged labor, cesarean section, instrumental delivery, episiotomy, fever in labor, and use of oxytocin.

Mnemonic for PPH Etiology

5 T’s: Tone (uterine atony), Tissue (retained placenta), Trauma (lacerations), Thrombin (coagulopathy), and Traction (uterine inversion).

Clinical Features of PPH

Bleeding, tachycardia, pallor, hypotension, slow capillary refill, and cold clammy skin.

Management of Primary PPH - Initial Resuscitation

Call PPH team, oxygen via mask, IV fluids, blood tests, crossmatch blood, and monitor urine output.

Uterine Atony

Failure of uterine contractions after placental delivery; most common cause of PPH.

First Line Treatment for Uterine Atony

Mechanical bimanual uterine massage and compression combined with pharmacological methods such as oxytocin.

Advanced Management for PPH

Includes examination under anesthesia, uterine tamponade, uterine artery embolization, and possible hysterectomy.

Retained Products of Conception

Failure of placental delivery within 60 minutes after fetal delivery; can lead to secondary PPH.

Sheehan's Syndrome

Postpartum pituitary necrosis due to severe hypotension and ischemic damage to the pituitary gland.

Asherman Syndrome

Intrauterine adhesions occurring after uterine trauma leading to infertility and menstrual irregularities.

Diagnosis of Uterine Atony

Soft, enlarged, boggy uterus typically associated with grand multiparity and prolonged labor.