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DELIVERY

EDC - "Every Drop Counts"

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"The 4 T's"

Every Drop Counts (EDC) and the 6 Ds
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Preceding Risk Factors for PPH

  • Big baby

  • Multiple pregnancies

  • Long labour

  • Infection

  • Previous PPH

  • Suspected difficult C section (such as Placenta previa, or Placenta accreta)

  • ​Bleeding tendency (i.e Von Willebrand's Disease)​

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*CBC is recommended on arrival in triage.

The 4 T's

Uterine aTony

Associations

  • Big baby

  • Multiple gestations

  • Long labour

  • Uterine stimulants for many hours

  • Previous uterine atony

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Implications

  • increased risk of PPH​

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Management

  • medications​

  • massage of uterus

  • empty bladder

Trauma

Associations

  • Perineal lacerations

  • Vaginal lacerations

  • Cervical tears

  • Uterine rupture

  • Operative delivery

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Implications

  • from little to massive bleeding

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Management

  • diagnose laceration, focus on site, pressure, help, and suture

Tissue retained

Associations

  • Poor management of the third stage

    • Waiting for uterus to contract before cord traction

    • Not checking to see if placenta complete

    • Difficult removal ("stuck placenta")

    • If in doubt explore the uterus with anesthesia or ultrasound if available

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Implications

  • increased risk of immediate, intermediate, late PPH

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Management

  • remove the retained tissue as soon as possible

Thrombin clotting issues

Associations

  • Toxemia

  • Long labour with excessive blood loss

  • Infection

  • Genetic issues with clotting factors

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Implications

  • Continuing blood loss, more loss of clotting factors

  • Need to supplement clotting factors

 

Management

  • Diagnose, help required. 

  • Lab involved for testing

  • Supplying clotting factors

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