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Obstetric Haemorrhage

Obstetric Haemorrhage. Promoting multiprofessional education and development in Scottish maternity care. Content. Antepartum haemorrhage Abruption Placenta Praevia Vasa praevia Uterine rupture Postpartum haemorrhage Uterine inversion. Antepartum haemorrhage. Consider Abruption

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Obstetric Haemorrhage

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  1. Obstetric Haemorrhage Promoting multiprofessional education and development in Scottish maternity care

  2. Content • Antepartum haemorrhage • Abruption • Placenta Praevia • Vasa praevia • Uterine rupture • Postpartum haemorrhage • Uterine inversion

  3. Antepartum haemorrhage • Consider • Abruption • Placenta Praevia • Vasa praevia • Uterine rupture • Idiopathic

  4. Saving Mothers’ Lives 2011 • 9 women died due to haemorrhage in 2006 – 2008, incidence of 0.39 per 100,000 maternities. • Severe Haemorrhage occurs in 1:200-250 deliveries

  5. Contributing Causes • 6 (66%) of these women received sub-standard care in due to failures in: • Ultrasound had not been performed despite previous history of Caesarean section • Multiprofessional management of placenta percreta. • Women who have a C/S must be on a MEOWS chart and abnormal recordings acted upon

  6. Placenta percreta/accreta

  7. Causes: Placental abruption

  8. Causes: Placenta praevia Grade 1 Grade 2 Grade 3 Grade 4 Minor Major

  9. Causes: Vasa Praevia

  10. Causes: Uterine Rupture Virtually never occurs in primigravidae. Associated with: obstructed labour in multiparous patients induction using prostaglandins following previous cesarean section (9:1000 VBAC) Obesity

  11. Causes: Uterine Rupture

  12. Management of APH • Dependent on: • amount of bleeding • maternal and fetal condition. • Major haemorrhage: • Resuscitate mother • Immediate delivery • LUSCS if fetus alive • Vaginal delivery may be appropriate if fetus dead.

  13. Postpartum Haemorrhage Risk Factors: Grand multiparity Multiple pregnancy Prolonged labour Fibroids Placenta praevia Placenta accreta APH Previous PPH Retained placenta Bleeding disorder.

  14. Recognise Act on clinical signs – do not wait for laboratory results. Look for shock (pallor, tachycardia, hypotension). Note: hypotension may not be apparent until approx 1.5 litres lost Beware the “trickle” Measure blood loss accurately!

  15. PPH Management • Call Help – most senior available • Nurse flat • Airway (facial O2) • Breathing (Respiratory rate, SaO2) • Circulation (HR, BP, refill time) • 2 wide bore cannulae Bloods FBC, XM, • IV crystalloid 2 litres – fast • Compression

  16. PPH (Continued) • Syntocinon 5 units slow bolus + Infusion • Ergometrine 500 micrograms IM/IV slowly • Carboprost (Hemabate) 250 micrograms IM (not IV) max 8 doses • Misoprostol 800 micorgrams PR • Bloods FBC, XM, • Coagulation screen • Catheter

  17. PPH • Consider cause 4Ts • Tone • Trauma • Tissue • Thrombus

  18. PPH Consider alternative measures to arrest bleeding • Rusch Balloon • Vaginal pack • B-Lynch • Hysterectomy • Embolisation

  19. Rusch Balloon

  20. B-Lynch Suture

  21. Embolisation

  22. Uterine Inversion

  23. Uterine Inversion

  24. Any Questions?

  25. Key Points React ahead of loss - think big Get big people involved early Beware the postpartum ‘trickle’.

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