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    Lisa Gilbert
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    Post partum haemorrhage Focus Group #4 – Lisa Gilbert Definitions • Primary postpartum haemorrhage (PPH) • blood loss > or = 500 mL, within 24 hours of vaginal delivery • >1000mL for caesarean delivery • Secondary PPH • blood loss of >500mL after 24hrs and up to 6 weeks postpartum • A major PPH • continued bleeding and failure to respond to first-line management and cases where blood loss is approaching or exceeding 1000mL Stats • PPH is the still the leading cause of maternal mortality wo

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    Post partum haemorrhage Focus Group #4 – Lisa Gilbert Definitions • Primary postpartum haemorrhage (PPH) • blood loss > or = 500 mL, within 24 hours of vaginal delivery • >1000mL for caesarean delivery • Secondary PPH • blood loss of >500mL after 24hrs and up to 6 weeks postpartum • A major PPH • continued bleeding and failure to respond to first-line management and cases where blood loss is approaching or exceeding 1000mL Stats • PPH is the still the leading cause of maternal mortality wo

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
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    92 views15 pages

    Post Partum Haemorrhage

    Uploaded by

    Lisa Gilbert
    Post partum haemorrhage Focus Group #4 – Lisa Gilbert Definitions • Primary postpartum haemorrhage (PPH) • blood loss > or = 500 mL, within 24 hours of vaginal delivery • >1000mL for caesarean delivery • Secondary PPH • blood loss of >500mL after 24hrs and up to 6 weeks postpartum • A major PPH • continued bleeding and failure to respond to first-line management and cases where blood loss is approaching or exceeding 1000mL Stats • PPH is the still the leading cause of maternal mortality wo

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 15

    Post partum haemorrhage

    Focus Group #4 Lisa Gilbert

    Definitions
    Primary postpartum haemorrhage (PPH)
    blood loss > or = 500 mL, within 24 hours of vaginal delivery
    >1000mL for caesarean delivery

    Secondary PPH
    blood loss of >500mL after 24hrs and up to 6 weeks postpartum

    A major PPH
    continued bleeding and failure to respond to first-line management and cases where blood loss is approaching or exceeding 1000mL

    Stats
    PPH is the still the leading cause of maternal mortality worldwide*
    The overwhelming majority of these deaths and complications occur in developing countries.

    Local Incidence
    Between 5 and 15% (Aus and NZ) Major PPH 1-2% at the Royal Womens For every maternal death, it is estimated that there are around 80 instances of near-miss where women experience a life-threatening complication
    Renal impairment Sheehan Syndrome Risk of blood borne diseases (from transfusion)

    Risk Factors Four Ts


    Tone Trauma Tissue Thrombin (Coagulopathies)

    Common Risk Factors

    Management
    First think prevention!!!
    Active management of 3rd stage
    administration of a uterotonic soon after the birth of the baby clamping of the cord following the observation of uterine contraction (at around 3 minutes) delivery of the placenta by controlled cord traction, followed by uterine massage.

    Emergency?

    ABC - call for help - 2 large bore IV line & blood investigations: FBC, U&E, LFT, Coag screen, group x-match) - crystalloid infusion - monitor vital signs

    Part II

    Summary Mx of PPH
    Uterine massage Medical
    Oxytocin +/- ergometrine IV/IM Oxytocin infusion IV Prostaglandin Misoprostol PR

    Bimanual compression (remember analgesia!) Surgical


    Repair genital tract injuries Uterine tamponade (Bakri balloon) Laparatomy
    B-Lynch suture Internal iliac/uterine A ligation hysterectomy (50%) Uterine Artery embolization Total/subtotal hysterectomy

    Practice Points
    It is important to remember that the clinical signs of haemorrhagic shock are delayed in the newly parturient woman due to the increased blood volume of pregnancy Two thirds of women who have a PPH have no known risk factors Visual estimation of blood loss is unreliable!
    Where possible blood loss should be estimated by weighing linen, drapes pads and swabs

    References
    All images available freely on the internet Royal Womens Clinical Practice Guidelines: Labour: Management of Post-Partum Haemorrhage, including Postnatal Care available at http://www.thewomens.org.au/LabourManagementofPostP artumHaemorrhageincludingPostnatalCare?searchTerms[] =pph WHO guidelines for the management of postpartum haemorrhage and retained placenta. Available at: http://www.who.int/reproductivehealth/publications/matern al_perinatal_health/9789241598514/en/index.html WHO Education material for teachers of midwifery: Midwifery education modules - second edition. Managing Post Partum Haemorrhage.

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