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Primary Post Partum Haemorrhage

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Primary Post Partum Haemorrhage


  • incidence <4%

Causes

  • 80%
    • atonic uterus
    • retained placenta
  • 20%
    • laceration of genital tract
    • uterine rupture
    • blood coagulation defect
  • prolonged labour
  • overdistension of uterus
  • antepartum haemorrhage
  • deep general anaesthesia

Prevention

  • prophylactic oxtytoxics
  • avoid fundal fiddling

Diagnosis

  • excessive bleeding
  • fundus rising in abdomen
  • contraction may expel blood clots if rubbed up

Management

3rd Stage Bleeding

  • stage 1
    • contraction rubbed up
    • fundal pressure and controlled cord traction to deliver placenta
    • if coontracts down and still bleeding then inspect lower vaginal tract for tear
  • stage 2
    • exploration of uterine cavity
    • manual evacuation of placenta under epidural / general anaesthesia
    • ergometrine 0.5mg IV + 0.5mg IM

True PPH

  • check to placenta to ensure complete
  • massage uterus with slow, rotary motion
  • infusion of Hartmanns solution
  • 0.25mg ergometrine IV or Syntocinon infusion (10U in 500ml)
  • syntometrine
  • mifepristone 600mg
  • carboprost 25mg IM/myometrial + 25mg at 5 mins if no response
  • may need blood transfusion
  • check for coagulation defects
  • inspect for lacerations
  • bimanual compression of uterus
  • embolisation, internal iliac artery ligation, hysterectomy
 

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