What is the golden hour in PPH?

However, according to our experience, the first hour following severe PPH (golden hour) seems to be the best timing for fibrinogen concentrate infusion to reduce the blood loss, transfusion requirements and surgical hemostasis.

What are the 4 stages of PPH?

What are the four most common causes of postpartum hemorrhage? The causes of postpartum hemorrhage are called the four Ts (tone, trauma, tissue and thrombin).

What do the 4 T's of PPH stand for?

• Ensure routine third stage oxytocic given. • 4Ts (tissue, tone, trauma, thrombin)

Which one of the 4 Ts is the most common cause of PPH?

Uterine atony.

This is the most common cause of PPH. It happens when the muscles in your uterus don't contract (tighten) well after birth. Uterine contractions after birth help stop bleeding from the place in the uterus where the placenta breaks away.

What is PPH protocol?

Procedures used in PPH management include manual removal of the placenta, manual removal of clots, uterine tamponade, and uterine artery embolization.

Golden Hour

Why do we give oxygen in PPH?

Enhancing oxygen delivery to myometrium through additional inhaled oxygen may improve uterine contractions. Therefore, it is reasonable to consider that oxygen inhalation may promote myometrial contraction and prevent postpartum haemorrhage (PPH) due to uterine atony.

What are interventions for PPH?

Procedures used in PPH management include manual removal of the placenta, manual removal of clots, uterine balloon tamponade, and uterine artery embolization. Laceration repair is indicated when PPH is a result of genital tract trauma.

What are the 5 T's causing postpartum hemorrhage?

There are four main causes of postpartum hemorrhage that account for the majority of cases. Also known as the “Four T's”, these are Tone (uterine atony), Tissue (retained placenta), Trauma (laceration), and Thrombin (coagulopathy).

What are the 3 main causes of postpartum hemorrhage?

Conditions that may increase the risk for postpartum hemorrhage include the following: Placental abruption. The early detachment of the placenta from the uterus. Placenta previa.

What are four risk factors for PPH?

Results: Major independent risk factors for PPH included primiparity, prior Caesarean section, placenta previa or low-lying placenta, marginal umbilical cord insertion in the placenta, transverse lie, labour induction and augmentation, uterine or cervical trauma at delivery, gestational age < 32 weeks, and birth weight ...

What is the first line treatment for PPH?

The available evidence suggests that oxytocin used as first‐line treatment of PPH probably is more effective than misoprostol with less side‐effects.

What are the 5 most common causes of PPH?

In many International and local studies it was revealed that the main cause of PPH is uterine atony followed by vaginal hematoma, cervical or vaginal tear, adherent placenta, uterine angle extension and retained placenta [3,5].

How much blood is considered a PPH?

A primary postpartum haemorrhage (PPH) is when you lose a lot of blood in the first day after giving birth. After a vaginal birth this usually means you have lost at least 500 mL (half a litre) of blood and after a caesarean section at least 1000 mL (a whole litre) of blood.

What is rule of 30 PPH?

Rule of 30 refers to a 30% fall in hematocrit, a 30 mmHg fall in systolic blood pressure, an increase by 30 beats/min of pulse rate, a 30% fall of hemoglobin (approximately 3 g/dl), and an approximate blood loss of 30% of normal (70 ml/kg in adults; 100 ml/kg throughout pregnancy).

What is the drug of choice for PPH?

Oxytocin is the drug of choice for preventing postpartum hemorrhage because it is at least as effective as ergot alkaloids or prostaglandins and has fewer side effects.

How long do you bleed after PPH?

Lochia, also known as postpartum bleeding, is vaginal bleeding after giving birth that includes bloody fluid made up of blood, placental tissue, sloughed off endometrial lining and mucous. Normal postpartum bleeding continues for 3 to 6 weeks as your uterus heals and returns to its usual shape and size.

What is the most common risk factor for PPH?

The No. 1 risk factor for PPH is atony — or atypical uterine contraction post-placental delivery. Overdistension of uterine muscle. This factor occurs most commonly after twin or large-infant delivery.

What IV fluids for postpartum hemorrhage?

During labor, place at least 1 intravenous line in women at risk for PPH; consider a second line in patients at very high risk. Perform the initial resuscitation with large volumes of crystalloid solution, either normal saline (NS) or Lactated Ringer's solution (LRS), through peripheral intravenous sites.

How does oxytocin help with postpartum hemorrhage?

Oxytocin prevents excessive postpartum bleeding by helping the uterus to contract. It is given to the mother by injection into a vein or into muscle during or immediately after the birth of her baby.

How can I stop postpartum bleeding faster?

How do you stop massive PPH?

Manual compression of the uterus, insertion of an intrauterine balloon for tamponade, placement of a uterine tourniquet, and/or ligation of the uterine and utero-ovarian arteries can reduce brisk ongoing heavy blood loss before placement of compression sutures.

What might you have to do during a PPH emergency?

Activate your massive transfusion protocol. Palpate the uterus to assess for atony. Perform uterine fundal massage. If no response, apply bimanual compression with one hand below the uterus in the vagina and the other compressing from above through the lower abdominal wall.

Why is the bladder empty during PPH?

Make sure she regularly empties her bladder to avoid interfering with normal uterine contractions, including immediately after birth. Use the partograph to monitor labour progress so that you quickly notice any signs that might potentially lead to PPH (e.g. obstruction leading to possible uterine rupture).

Why does PPH cause tachycardia?

As the loss of blood occurs in postpartum hemorrhage, the patient is at risk of hypovolemic shock. When the patient loses 20% of the blood, they develop tachycardia, tachypnea, narrowed pulse pressure, and delayed capillary refill. This may lead to ischemic injury to the liver, brain, heart, and kidney.

What is the nursing care of PPH?

Nursing Interventions

Save all perineal pads used during bleeding and weigh them to determine the amount of blood loss. Place the woman in a side lying position to make sure that no blood is pooling underneath her. Assess lochia frequently to determine if the amount discharged is still within the normal limits.