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! ;)

links: B-Lynch suture technique from RCOG

For House Officers out there, don't forget what you have to do in an emergency of PPH in the ward:

- ABC
- 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

Medical

→ 500mcg ergometrine IV/IM

→ Oxytocin infusion (40IU) → 10IU IV

→ Carboprost 250mcg IM (up to 4 doses)

→ misoprostol 800-1000 mcg PR

Bimanual compression

Surgical

Repair genital tract injuries

Uterine temponade (Rusch balloon)

Laparatomy

· B-Lynch suture

· Internal iliac/uterine A ligation → hysterectomy (50%)

· Uterine A embolization

· Total/subtotal hysterectomy

Prevention:

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