POSTPARTUM HAEMORRHAGE
POSTPARTUM HAEMORRHAGE
A postpartum haemorrhage is any bleeding from the genital tract, following the birth of a baby, of more than 500mls or any amount that adversely affects the mother. A primary postpartum haemorrhage occurs within the first 24 hours, a secondary postpartum haemorrhage occurs after 24 hours up to 12 weeks post partum.
Potential risk factors for postpartum haemorrhage
Multiple pregnancy
Macrosomia
Polyhydramnios
Grandmultiparity
Retained placenta
Augmented labour
Placenta previa
Antepartum haemorrhage
Instrumental birth
Caesarean Section
Clotting Disorders
Previous PPH
4 categories that cause postpartum haemorrhage
Tone (70%)
Grand Multiparity
Multiple pregnancy
Polyhydraminos
Macrosomia
Abnormalities: fibroids
Prolonged labour
Precipitate labour
Dysfunsctional labour
Intrauterine infection
Uterine relaxing agents (Magnesium / general anaesthetic/ tocolytics)
Trauma
Operative delivery
Cervical / vaginal lacerations
Previous caesarean section increases risk of morbidly adherent placenta
Tissue
Retained placental tissue or membranes
Thrombin
Pre-eclampsia
HELLP Syndrome
Placental abruption
Amniotic Fluid Embolism
Sepsis
Bleeding disorders
Drugs (aspirin / heparin)
Potential Consequences of PPH
Shock
Maternal Death
DIC
Hysterectomy
Treating a Primary Postpartum Haemorrhage
Pull emergency bell and call 2222 and ask for Obstetric Emergency and Anaesthetic Team
Need Senior Obstetrician, Senior Midwife, Anaesthetist, ODP, Scribe, Porter
Notify Haematologist
Lie woman flat and assess ABC
Give oxygen 15l via non rebreathe mask, record observations and monitor resps, pulse and O2 sats continuously and BP every 5mins
Assess uterine tone and rub up a contraction if lax/boggy
Give Ergometrine 0.5mg I.M max two doses if not hypertensive
Set up IV syntocinon – 40IU/500mls normal saline over 4 hours or 40IU/40ml if fluid restricted
Carboprost 0.25mg IM every 15 minutes (max 8 doses – 2mg) not if asthmatic (Obstetrician can give myometrically 0.5mg)
A postpartum haemorrhage is any bleeding from the genital tract, following the birth of a baby, of more than 500mls or any amount that adversely affects the mother. A primary postpartum haemorrhage occurs within the first 24 hours, a secondary postpartum haemorrhage occurs after 24 hours up to 12 weeks post partum.
Potential risk factors for postpartum haemorrhage
Multiple pregnancy
Macrosomia
Polyhydramnios
Grandmultiparity
Retained placenta
Augmented labour
Placenta previa
Antepartum haemorrhage
Instrumental birth
Caesarean Section
Clotting Disorders
Previous PPH
4 categories that cause postpartum haemorrhage
Tone (70%)
Grand Multiparity
Multiple pregnancy
Polyhydraminos
Macrosomia
Abnormalities: fibroids
Prolonged labour
Precipitate labour
Dysfunsctional labour
Intrauterine infection
Uterine relaxing agents (Magnesium / general anaesthetic/ tocolytics)
Trauma
Operative delivery
Cervical / vaginal lacerations
Previous caesarean section increases risk of morbidly adherent placenta
Tissue
Retained placental tissue or membranes
Thrombin
Pre-eclampsia
HELLP Syndrome
Placental abruption
Amniotic Fluid Embolism
Sepsis
Bleeding disorders
Drugs (aspirin / heparin)
Potential Consequences of PPH
Shock
Maternal Death
DIC
Hysterectomy
Treating a Primary Postpartum Haemorrhage
Pull emergency bell and call 2222 and ask for Obstetric Emergency and Anaesthetic Team
Need Senior Obstetrician, Senior Midwife, Anaesthetist, ODP, Scribe, Porter
Notify Haematologist
Lie woman flat and assess ABC
Give oxygen 15l via non rebreathe mask, record observations and monitor resps, pulse and O2 sats continuously and BP every 5mins
Assess uterine tone and rub up a contraction if lax/boggy
Give Ergometrine 0.5mg I.M max two doses if not hypertensive
Set up IV syntocinon – 40IU/500mls normal saline over 4 hours or 40IU/40ml if fluid restricted
Carboprost 0.25mg IM every 15 minutes (max 8 doses – 2mg) not if asthmatic (Obstetrician can give myometrically 0.5mg)