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Primary PPH (AETIOLOGY (4 T's) (THROMBIN (PRE-EXISTING --> VW…
Primary PPH
AETIOLOGY (4 T's)
TONE: Uterine Atony. RFs --> Polyhydramnios, Macrosomia, Multiple Gestation, Placenta Praevia, Intraamniotic Infection, Prolonged Labour.Rapid Labour/High Parity (Uterine Exhaustion)
TISSUE: Retained Products of Conception. RF's --> Incomplete placenta on delivery, previous Uterine surgery, known abnormal placenta on USS
TRAUMA: Uterine rupture or inversion, Lacerations of cervix/vagina/perineum
THROMBIN
PRE-EXISTING --> VW Disease, Others
ACQUIRED in PREG --> ITP, Thrombocytopenia with PET, DIC, Severe Infection, Amniotic Fluid Embolus
Rx
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DRUG
Oxytocin (trade name Syntocinon)
• Oxytocin plus ergometrine (trade name Syntometrine)
• Ergometrine
• Misoprostol (sublingual) usually given rectally in this setting
SURGICAL
Under GA --> Repair identifiable trauma, potential Laparotomy and Hysterectomy for severe cases
DEFINITION
500mLs EBL in the first 24hrs after Delivery
PREVENTION
Antenatal and Intrapartum Assessment of Risk most important. Active management of 3rd Stage of Labour.
TONE: Massage + Oxytocic Drugs
TISSUE: Controlled Cord Traction via Brandt Andrews Method (guarding fundus to prevent inversion) + Examine Placenta to ensure it is complete + Curettage may be required.
TRAUMA: Surgical repair of identified trauma, correct inversion.
TISSUE: Detect and manage antenatally, reverse anticoagulation Rx, Replace factors.
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