Transcript Major Obstetric haemorrhage

Major Obstetric haemorrhage
Miss Melanie Tipples
Objectives
 Understand the definition and causes of major
haemorrhage
 Recognise and manage a collapse from haemorrhage
 Understand the surgical and pharmacological options
for management of haemorrhage
Haemorrhage
 Major cause of morbidity and mortality for all
pregnant women through pregnancy and in post
partum period
 Reduction in deaths in last triennial report but still
major cause of death
 Substandard care found in 3 out of five cases (no obs,
concealed bleeding not considered)
 MEOWS charts for 24 hours post section and need for
action where abnormalites found
Definition
 Major Obstetric Haemorrhage is defined as the loss of
more than 1000mls of blood either antepartum or
post partum
Causes
 T – Tone (multiple causes both fetal and maternal)
 T – Tissue Retained tissue (placenta or products)
 T - Trauma Genital tract injury, broad ligament
haematoma, uterine rupture
 T- Thrombin ie coagulopathy secondary to
haemorrhage, abruption, sepsis, eclampsia or dead
fetus, amniotic fluid embolus
 It can be caused by one or more of the above
Management
 Identifying you have a problem – look for signs of
shock (concealed or revealed)
 Pulse, respiratory rate, peripheral perfusion, urine
output
 Remember blood pressure drops late
 Acidosis and confusion/drowsy
Management
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Communication and documentation
Call for help
Resuscitation (ABC)
Fluid replacement
Arresting the bleeding and obstetric intervention
Monitoring and investigation
Anaesthetic inpurt
TEAM APPROACH
 MAJOR OBSTETRIC HAEMORRHAGE CALL
 Make sure you know what that means in your hospital
 Allocate a team leader
Rescucitation
 A – Oxygen
 B – Assess
 C – two large bore cannulas (grey) and take bloods
for FBC, u&es, coag, and cross match. Commence
ward colloid infusion
 Place on oximeter, BP cuff, Insert catheter
Management -Tone
 Bimanual compression of uterus
 Empty bladder
Tone - pharmocology
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Syntocinon 5 units
Ergometrine 0,5mg iv/im
Sytocinon 40 in 500mls n/saline
Carboprost 0.25mg im every 15 minutes to a max of 8
injections
 Misoprostol 600 microgrammes oral or pr (asthma or
home deliveries)
Tone – surgical tecniques
 Tamponade balloon
 Haemostatic brace lynch suture
 Selective arterial embolization
Management - Tissue
 Failure to respond to pharmolocogical techniques,
intermittent relaxation or suspicion that the placenta
is incomplete should prompt examination of the
uterine cavity under anaesthetic
Management - Trauma
 Surgical exploration and repair
 If repair not possible Hysterectomy may be indicated
 Timely definitive surgery has been shown to be
associated with best outcome
Management - Thrombin
 Involve Haematologist and MLSO early
 Update them regularly
 Remember to stand them down
Post Haemorrhage
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Documentation
Datix
Debrief
Follow up patient and arrange support
Summary
 Systematic approach and team working has been
shown to improve outcome in the most recent
CMACE report