Postpartum Haemorrhage

Basic approach to PPH
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1. Postpartum HAEMORRHAGE Definition Prevention Causes Management Test your knowledge Recommended Reading

2. What is PPH Primary PPH occurs in the fist 24 hours after delivery Blood loss >500ml after a vaginal delivery, OR > 1000ml at caesarean section Secondary PPH is defined as excessive vaginal bleeding from 24h after delivery up to 6 weeks postpartum

3. Prevention of PPH

4. Establish CAUSE of haemorrhage Good history and systematic examination to determine risk factors and cause Management directed towards the cause

5. management   Resuscitation IV Line with 30u Pitocin ( Syntometrine 1 amp if no c/ i ) Misoprostol 5 tabs pr Tranexamic acid 1g ivi Rub up the uterus Urine catheter Estimate blood loss Determine cause of pph Manage as per cause (view QR code) Watch this video that illustrates the STRICT PROTOCOL MANAGEMENT of PPH

6. Test your knowledge Mrs x delivered a baby 15 minutes ago. The delivery of the placenta was difficult and she is now bleeding profusely. The uterus cannot be palpated abdominally. Which drug do you ask your assistant to administer as part of management of Mrs X? TOCOLYTIC OXYTOCIC More questions

7. correct Congratulations, you have just helped save a life!

8. incorrect Mrs x continues to bleed. Please keep trying to save her life Hint: Her most likely diagnosis is uterine inversion

9. Recommended reading Chandraharan , E., & Krishna, A. (2017, 10 06). Diagnosis and Management of Postpartum Haemorrhage. BMJ, 358-363. Retrieved from https://medikoe.com/article/POST-PARTUM-HEMORHAGE-1312 Higgins, N., Patel, S. K., & Toledo, P. (2019). Postpartum hemorrhage revisited: new challenges and solutions. Current Opinion in Anesthesiology , 278-284. Khalid, K. (2019, October 06). Post Partum Haemorrhage. Retrieved from Medikoe : https://medikoe.com/article/POST-PARTUM-HEMORHAGE-1312 Makhubo , N., JD, Makin., & S, Adam. (2018). Use of a visual aid to improve estimation of blood loss in obstetrics. SAJOG, 18-21. O'Brien, K. L., Shainker , S. A., & Lockhart, E. L. (2018). Transfusion Management of Obstetric Hemorrhage . Transfusion Medicine Reviews, 249-255. Sentilhes , L. ,.‐J. (2018). FIGO consensus guidelines on placenta accreta spectrum disorders: Conservative management. Int J Gynecol Obstet , 291-298 .