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Ob-Gyn OSCE PPH
Ob-Gyn OSCE PPH
General inspection:
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Time since parturition: is this an early or delayed PPH? Is this a still-open caesarean?
Vitals: Temp, Pulse, Respiration, BP, capillary refill
How much blood has already been lost? What management has already been
attempted?
Call for help
Relevant history:
o Placenta location and nature (praevia, accrete)
o Medications, recent FBE / Hb
Examine:
-
Manage:
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Other questions:
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Cause of early PPH: retained POC, coagulopathy, uterine / cervical / vaginal tear,
Cause of late PPH: coagulopathy, sloughing of scar, infection, retained POC
Risks of severe PPH: pituitary infarction, renal failure, ARDS
Risks of treatment: subfertility / infertility, loss of uterus, loss of ovaries (and resultant
surgical menopause)
Definition: >500mls of haemorrhage, either first 24hrs, or beyond 24hrs
Risk factors for PPH:
o Twins, polyhydramnios, macrosomia
o Placenta praevia, placenta accrete (absence of decidua layer), retained products
of conception
o Prolonged 1st or 2nd stage, instrumented delivery, natural 3rd stage of labour
o Uterine abnormalities or POC disrupting uterine contractions
o Pre-existing anaemia, coagulopathy, haemophilias
o Prior PPH, prior uterine procedures / instrumentation, uterine abnormalities