The 4 Ts
What are the 4 T’s of PPH?
Tone, Tissue, Thrombin, Trauma
First vital sign to change in PPH?
Tachycardia
First action for heavy bleeding?
Call for help and massage the fundus
First line uterotonic?
Oxytocin
Definition of PPH after vaginal birth?
Blood loss >500ml
What is an example of tone cause
Uterine atony, boggy, full bladder
What to do if the uterus feels boggy?
Massage the fundus
Positions to improve perfusion
Flat or Trendelenburg
What medication is contraindicated in hypertension
Ergot
Definition of PPH after c-section?
Blood loss >1000mL
Example of Tissue cause?
Retained placenta or membranes
Why does prolonged oxytocin infusion predispose to PPH
Receptor desensitization-->becomes less responsive to oxytocin.
why is BP often normal until later PPH
Pregnant patients have increased blood volume so they are able to compensate for longer before hypotension occurs
What medication is contraindicated in asthma
Hemabate
Most common cause of PPH?
Uterine atony
Example of Trauma cause?
Lacerations or uterine rupture
Cause if continued bleeding despite firm fundus?
Laceration, retained placenta, coagulation.
Mechanical intervention if meds fail?
Bakri ballon
TXA dose
1 g over 10 min within 3 hours of delivery
How much blood loss before symptoms appear?
15-30%
Example of Thrombin cause?
Coagulopathy (DIC)
What is the correct fluid to inflate a bakri balloon
NS, sterile saline NOT air
Surgical option for uncontrolled PPH?
Hysterectomy
How does magnesium sulfate increase risk for PPH
Acts as a Smooth muscle relaxant reducing uterine tone
Gold standard for assessing blood loss?
Quantitative blood loss (QBL)