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Primary Post Partum Haemorrhage
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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