Maternity

PPH definition

More than 500ml up to 6 weeks after birth. Primary PPH <24hrs secondary PPH 6weeks >24hrs

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How does homeostasis work to prevent PPH in pregnancy?

Uterine walls come into apposition encourage pressure on bv.
Living ligatures provide interlaced fibres stem blood.
Clotting mechanisms enhanced - fibrin mesh formed over placenta bed site

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What are the causes of PPH?

Tone
Trauma
Tissue
Thrombin

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Definition of antepartum haemorrhage?

Bleeding in pregnancy after 24 weeks, before labour

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What are the two main causes of APH?

Placental abruption - retro placental haemorrhage
Placenta praevia - placenta lies over cervix opening (mortality 5-15%)

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Maternal haemorrhage control techniques

Fundal massage
TXA 1g
Misoprostol 800mcg
Bimanual compression

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Cord prolapse

Alongside (occult)
In front (overt)
Problem - cord compression = diminished blood supply,+ temp differences = spasm

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Cord prolapse management

Replace
Position - knee chest
Walk
Position
Assess + entonox

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Shoulder dystocia

Anterior shoulder impacts maternal symphysis pubis
Posterior shoulder impacts sacral promontory

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Shoulder dystocia management

Start - clock + note time of head delivery
Stop - stop pushing
State - to crew and mom
Reposition - mcroberts
Suprapubic pressure

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Breech / malpresentation

Hands off
Breech, brow presentation, transverse lie

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Neonatal metabolic triangle

Hypothermia
Hypoxia
Hypoglycaemia

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NLS

Assess - APGAR
5 inflation breaths
APGAR
30 sec ventilation
APGAR
3:1 - 30 secs

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What is APGAR

Appearance
Pulse
Grimace
Activity
Respiration

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Maternity

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