Post Partum hemorrhage

Post-Partum Haemorrhage

Blog written by – Dr Andrew Lam

Criteria for PPH:

• Cumulative blood loss >1L OR bleeding with signs/symptoms of hypovolemia within 24 hours of delivery
• Criteria remain the same, regardless of route of birth

Causes of PPH:

• Uterine atony
• Placental disorders (i.e. placenta praevia, placenta accreta, retained placenta, 
• Trauma (i.e. vaginal tears, episiotomies, myometrial/uterine rupture)
• Existing coagulopathy/bleeding diathesis

Management of PPH:

Supportive

• Reversal of coagulopathy with blood products (i.e. Prothrombinex, FFP, cryoprecipitate, tranexamic acid)
• Red blood cell transfusion with consideration of MTP

Definitive

• Reversal of existing tears/rupture
• Reversal of uterine atony (uterotonic agents, bimanual compression/massage)
• Intra-uterine balloon (Bakri balloon)
• Arterial embolisation
• Surgical laparotomy (Uterine compression sutures, ligation of uterine arteries, hysterectomy)