Sunday, December 19, 2010

PostPartum Haemorrhage (PPH)

I would consider myself lucky to be on-call on 2 nights in a week whereby 2 cases of PPH occurred requiring surgery. The best part is that I don't have to be the House Officer running back and forth to the blood bank, instead I was inside the OT to witness:

1. Total hysterectomy
- Para 4

2. B-Lynch suture
- Para 1 (with triplet pregnancy)

I have always been reading up and presenting about B-Lynch suture when I was a medical student. Now, after witnessing it with my own eyes, I think it is so cool! ;)

For House Officers out there, don't forget what you have to do in an emergency of PPH in the ward:
- call for help (red alert)
- 2 large bore IV line & blood investigations: FBC, U&E, LFT, Coag screen, group x-match)
- crystalloid infusion
- monitor vital signs

Management of PPH
Uterine massage
→ 500mcg ergometrine IV/IM
→ Oxytocin infusion (40IU) → 10IU IV
→ Carboprost 250mcg IM (up to 4 doses)
→ misoprostol 800-1000 mcg PR
Bimanual compression
Repair genital tract injuries
Uterine temponade (Rusch balloon)
· B-Lynch suture
· Internal iliac/uterine A ligation → hysterectomy (50%)
· Uterine A embolization
· Total/subtotal hysterectomy

Active management of 3rd stage (AMTS) – syntometrine, CTT, uterine massage