Primary Post Partum Haemorrhage (PPH) by zqa20601

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									                PRIMARY POST PARTUM HAEMORRHAGE


Definition

Bleeding from the genital tract of 1000ml or more or any amount that adversely
affects the woman within the first 24 hours following delivery (ALSO 2001)
N.B. The specific causes of PPH can be remembered by the mnemonic 4Ts
Tone, Tissue, Trauma, Thrombin

Aim

To maintain adequate circulation and instigate appropriate action to minimise
further blood loss.

Management

Ensure the following first line management of PPH has been instigated:
Tone

      Rub up a contraction
      Administer syntometrine 1ml intramuscularly or ergometrine 0.5mg
      intravenously. N.B. give Syntocinon 5 units if patient is hypertensive
      Catheterise patient

Tissue

      Deliver the placenta if not already delivered-if placenta retained follow
      guidelines for manual removal of placenta
      If the patient continues to bleed then proceed as follows:

SIMULTANEOUSLY

      Summon emergency obstetric team, state obstetric emergency, give
      location and state anaesthetist, obstetrician required Paediatrician may
      be required
      Assess maternal condition- and provide appropriate support
         1. A-Airway-check airway is clear
         2. B-Breathing-check breathing, administer 100% oxygen at 6 litres
             per minute
         3. C-circulation-cannulate 2x 16 gauge venflons. Obtain blood for
             FBC, clotting studies and group and cross match

NB Alert blood bank

      Monitor and record maternal blood pressure, pulse and oxygen
      saturation level.
      Commence Intravenous Syntocinon 40 units in 500mls of 0.9% Normal
      Saline at 125 mls. per hour.


County Durham and Darlington Acute Hospitals NHS Trust 2003
Primary Post Partum Haemorrhage                                  Page 1 of 1
Tone
       If bleeding persists and uterus atonic perform bimanual compression of
       the uterus until assistance is available

If bleeding persists and the uterus is well contracted consider the following:-


Trauma

       Inspect genital tract for trauma and manage appropriately
       Consider ruptured uterus


Tissue

       Examine placenta


Thrombin

       Consider coagulopathies

Theatre will need to be arranged for exploration of uterine cavity under G.A.

Haemabate       (Carboprost) should be considered after consultation with
Consultant on Call
Initial dose 250 mcg (1ml) of Haemabate IM
500mcg can be given directly into the uterine wall
If required further doses of 250mcg can be administered at intervals of 11/2
hours. In severe cases the interval between doses may be reduced to 15
minutes at the discretion of the Consultant Obstetrician. The total dose of
Haemabate should not exceed 2mgs (8 doses)


Contraindications

Cardiac, pulmonary, Renal and hepatic disease


Caution

Asthma
Anaemia
Hypertension
Hypotension
Previous Caesarean Section
Diabetes
Glaucoma
Epilepsy


County Durham and Darlington Acute Hospitals NHS Trust 2003
Primary Post Partum Haemorrhage                                      Page 2 of 2
If bleeding persists proceed to management of massive obstetric haemorrhage
guidelines

References
ALSO (2001) Advanced Life Support in Obstetrics UK

Griffiths, D. Howell-Behir, C. (2001) (IN) Moet Provider Manual 2001 Section 22
Page 7

Moet 2001 Provider Manual




Review:

3 yearly or as national, regional, local or professional bodies require.


Implementation date February 2003




County Durham and Darlington Acute Hospitals NHS Trust 2003
Primary Post Partum Haemorrhage                                       Page 3 of 3

								
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