Postpartum Haemorrhage

An overview of a very important obstetric emergency - postpartum haemorrhage (PPH).

 

Lecture by

Video Duration: 27 minutes

  • Postpartum Haemorrhage
    Created by Alison Thornton
    General
    Epidemiology

    500ml+ blood loss in the first 24hrs post-delivery

    • up to 1L = minor
    • 1L + = major

    up to 10% incidence - minor

    up to 2% incidence - major


    Secondary PPH is 24hrs - 6wks post delivery

    Pathology

    Bleeding fails to stop after the 3rd stage of labour


    Top three causes

    Causes are the 4Ts =

    • Tone - common, uterine atony, distended bladder
    • Trauma - lacerations in birth
    • Tissue - 2nd most common, retained placenta, clots
    • Thrombin - pre-existing/acquired coagulopathy
    Clinical Features
    Symptoms
    • Active bleeding
    Signs

    Signs of hypovolaemic shock :

    • Tachycardia
    • Hypotension
    • Tachypnoea
    • Skin mottling
    Investigations
    Cultures

    May use cultures to investigate if secondary PPH (endometritis etc.)


    don't have time for investigations in a primary PPH as it is an EMERGENCY

    Bloods

    Cross match

    group and save

    Imaging

    None

    Scopic/Biopsy

    None

    Functional

    NONE

    Treatment
    Conservative

    ABCDE assessment

    2L Hartmanns

    Rub up a contraction , bimanual compression

    Call theatres and obstetric teams - EMERGENCY

    Medical

    1. Syntocinon - 10 units per hr

    2. Misoprostol

    3. Carboprost

    Surgical

    Likely to need surgical management of the cause