Post Partum Haemorrhage

Primary PPH

>500 ml, first 24h from delivery.

• Retained Placenta/Products
• Atony
• Ruptured uterus
• Trauma

Prophylaxis: Syntometrine (500 mcg ergometrine, 5 units syntocinon)

Risk factors

• over-distension of uterus
• twins
• polyhydramnios
• multiparity
• antepartum haemorrhage
• fibroids
• bleeding tendency
• pre-eclampsia
• past history of post-partum haemorrhage

Initial Management

1. O₂
2. Call for help
3. Two 16G cannulae
4. X-match 4 units, ± platelets, Hb, clotting
5. IV Hartmanns, Blood replacement
6. Check Hx of of incomplete placenta/membranes
7. Examine uterus to ensure contracted
8. Examine cervix/vagina to exclude tears
9. Examine cervix to exclude retained placenta in cervical canal - shock
10. Catheterise, hourly urine output
11. Inform Obstetric Registrar

Mx major haemorrhage due to atony:

1. Rub up a contraction/bimanual compression
2. Syntocinon 10 i.u. iv. repeated (V/D)
3. Syntocinon 40 i.u./500 ml saline over 4 hours
4. Ergometrine 0.5 - 1.0 mg (Avoid in hypertension = V/C), causes nausea, vomiting, headache
5. If continuing (>1500 ml):
6. Prostaglandin E2 5 mg in 500 ml saline - 10 mcg/minute for 2 minutes then 20 mcg/min
7. Carboprost (Hemabate) 250 mg in 1 ml, deep IM or into myometrium. Repeat every 90 mins (max 12 g = 48 doses). Avoid prostaglandins in asthmatics and cardiac disease
8. Surgery - EUA, repair rupture, internal iliac A ligation, hysterectomy

Definition

>500ml after 24 h from delivery

Usually minor compared to primary. For review by Obs registrar

1. Antibiotics (ceph/met)
2. USS
3. EUA/ERP

Causes

• Retained products
• Trauma
• Infection