An overview of post-partum haemorrhage

1. Post Partum Haemorrhage
Dhammike Silva
Senior Lecturer
Faculty of Medicine USJP

2.  Primary
 Loss of 500ml of blood within 24hrs after delivery
 Major PPH >1000ml
 Secondary
 Blood loss greater than expected
24hrs to 12 weeks
Definition

3.  Developed countries 5%
 Sri Lankan
 2014 Maternal mortality 113 (MMR 33.7)
 PPH 11
 2015 Maternal mortality 112 (MMR 32.03)
 PPH 10
 Morbidity & near misses are much more higher than
mortalities
Incidence
Family Health Bureau Sri Lanka

4.  TOO LITTLE….... TOO LATE…...
Blood transfusion in PPH

5.  Antenatal diagnosis
 Oral iron
 Parental iron
 Active management of third stage
Reducing Risk of BT

6.  CONSENT
 SAMPLES FOR CROSS MATCHING
 ABO, Rh D and KELL
 CMV SERONEGATIVE RED CELL AND PLATELETS –
UNIVERSAL LEUCOCYTE DEPLETION
 GROUP O ,Rh D NEGATIVE ,KELL NEGATIVE

7.  PROPERATIVE/PREDELIVERY AUTOLOGOUS BLOOD
DEPOSIT
 INTRAOPERATIVE CELL SALVAGE
MINIMISING USE OF BANKED BLOOD

8.  PROTOCOL
 SKILLS AND DRILLS
 MECHANICAL STRATEGIES
MANAGEMENT

9. WHEN ?
O , Rh D NEGATIVE
WHAT COMPONENTS ?

10. Ideally same group but others possible
12-15 ml / kg
Maintain PT and APTT
Regular FBC, and coagulation screen during PPH
Cryoprecipitate – standard dose of two 5 unit pools
then according to Fibrinogen ( aim at levels > 1.5 g/l )
Fibrinogen 2.9 g / l ( normal 3.5 – 6.5 in pregnancy)
Viral transmission
FFP and CRYOPRECIPITATE

11.  Aim
 Transfusion trigger
 Ideally Group compatible
 ABO Non identical possible – HLA matched
 Anti D
Platelets

12.  Initiates blood coagulation
 Arterial thrombosis
 No RCT’S in PPH
 Incidence of Thrombotic complications 2.5 %
Recombinant factor VII a

13.  THROMBOELASTOGRAPHY ( TEG)
 ROTATION THROMBOELASTOMETRY ( ROTEM)
 VALIDATED TRANSFUSION ALGORITHM PROTOCOL
 QUALITY ASSURANCE MEASURES
 NO RCT’s
NEAR PATIENT TESTING

14.  No place still
Fibrinogen concentrate

15.  Tranexamic Acid
 Misoprostol
Antifibrinolytics and Misoprostol

17. Aetiology

21. B Lynch

24. Airway, breathing, O2 10-15L/min, RR
Consciousness
Reassurance
14G cannula,
Blood 20ml FBC Coag, cross match
Hartmann 2L
Colloids 1.5L
Blood, FFP, Platelets, Cryoprecipitate
Monitoring
Oxytocin bolus infusion
Ergometrine bolus
PGF2 alpha IM/ direct
Tranexemic acid/ Factor VII
Foley catheter
Misoprostol 1000mg
Tone, Trauma, Retained products
Uterine massage
Communication

25. Thank you.....