BASICS
Definition of primary PPH after vaginal delivery
≥500 mL blood loss within 24 hours postpartu
Most common “T” in PPH
Tone (uterine atony)
A pregnancy complication with increased amniotic fluid that raises PPH risk
Polyhydramnios
Most reliable method to measure PPH
Quantitative blood loss ( weighing drapes /pads)
First physical maneuver for uterine atony.
Uterine massage
Definition of primary PPH after cesarean delivery
≥1000 mL blood loss within 24 hours postpartum
“T” that includes uterine rupture and cervical lacerations
Trauma
Type of labor duration that increases risk
Prolonged and rapid labor
Earliest sign that changes in acute blood loss
Tachycardia
First line drug for uterine atony
oxytocin
Time range for secondary PPH
24 hours to 12 weeks postpartum
“T” related to retained products of conception
Tissue
Placental complication strongly associated with massive PPH
Placenta accreta spectrum
What does uterine atony feels like?
boggy
Antifibrinolytic used within 3 h of birth
TXA
Most common cause of maternal mortality worldwide
PPH
“T” that includes coagulopathies
Thrombin
2 fetal causes that increases risk of uterine atony
Macrosomia , Multiple gestation
One sign of hypovolemic shock besides tachycardia and hypotension
pallor , oliguria , confusion
Uterotonic contraindicated in hypertension
methlergonovine ( Ergot)
WHO-recommended first-line uterotonic
Oxytocin
Give one example of a cause for each of the 4 Ts
Tone: overdistension
Tissue: placenta accreta
Trauma: perineal tear
Thrombin: DIC
Risk factors that significantly raises recurrence for PPH
Previous PPH
Why visual estimation is unreliable
Underestimates actual blood loss
Non pharmaceutical management for PPH when first line does not work
- mechanical uterine compression ( bimanual massage )