stray scribbles ~ obgyn: postpartum hemorrhage

definitions

• postpartum hemorrhage (PPH): blood loss of >500ml blood after a vaginal delivery or >1000ml after a C/S or >1500ml after a repeat C/S
• primary (early) pph: pph occuring within the first 24 hours after delivery
• secondary (late) pph: pph occuring between 24 hours and 6 weeks after delivery

causes - the 4 Ts

• Tone - uterine atony
• Trauma - vaginal/cervical/perineal tears
• Tissue - retained placental tissue
• Thrombin - coagulopathies

it's an obstetric emergency!!!


what to do

• uterine fundal massage
• call for help at the same time
• get someone else to continue fundal massage or to get patient obs/vitals/amt blood loss and insert 2 large bore IV cannulae - send off bloods for group and crossmatch, FBC, platelets, coagulation studies and run IV fluids + syntocinon
• if bleeding still persist, give IM ergometrine or IM syntocinon
• check for obvious causes of bleeding such as tears, retained placental tissues (check placenta for completeness)
• if bleeding still persists or cause of bleeding found, take to OT and repair/explore under anesthesia
• if bleeding persists, give direct injection of PGF2-alpha to uterus
• if bleeding persists, opt for surgical management - ligation of uterine arteries, hypogastric arteries or hysterectomy at worst case