obstetric haemorrhage
DESCRIPTION
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 - PowerPoint PPT PresentationTRANSCRIPT
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Multidisciplinary
Obstetric Haemorrhage
Promoting multiprofessional education and development in Scottish maternity care
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MultidisciplinaryContent
• Antepartum haemorrhage
• Abruption• Placenta Praevia• Vasa praevia• Uterine rupture
• Postpartum haemorrhage
• Uterine inversion
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Multidisciplinary
Antepartum haemorrhage
• Consider
• Abruption• Placenta Praevia• Vasa praevia• Uterine rupture
• Idiopathic
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MultidisciplinarySaving 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
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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
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Placenta percreta/accreta
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MultidisciplinaryCauses: Placental abruption
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MultidisciplinaryCauses: Placenta praevia
Grade 1 Grade 2 Grade 3 Grade 4
Minor Major
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Causes: Vasa Praevia
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MultidisciplinaryCauses: 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
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MultidisciplinaryCauses: Uterine Rupture
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MultidisciplinaryManagement 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.
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Risk Factors:
Grand multiparityMultiple pregnancyProlonged labour FibroidsPlacenta praevia Placenta accretaAPH Previous PPHRetained placenta Bleeding disorder.
Postpartum Haemorrhage
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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!
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MultidisciplinaryPPH 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
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MultidisciplinaryPPH (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
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MultidisciplinaryPPH
Consider cause 4Ts
• Tone
• Trauma
• Tissue
• Thrombus
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MultidisciplinaryPPH
Consider alternative measures to arrest bleeding
• Rusch Balloon• Vaginal pack• B-Lynch• Hysterectomy• Embolisation
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MultidisciplinaryRusch Balloon
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MultidisciplinaryB-Lynch Suture
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MultidisciplinaryEmbolisation
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MultidisciplinaryUterine Inversion
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MultidisciplinaryUterine Inversion
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Any Questions?
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Key Points
React ahead of loss - think big
Get big people involved early
Beware the postpartum ‘trickle’.