Table 1 The four T mnemonic. Causes, incidences and factors associated with PPH
From: Primary and secondary postpartum haemorrhage: a review for a rationale endovascular approach
CAUSES | RELATED FACTORS | |
|---|---|---|
UTERINE ATONY (TONE, 70% incidence) | Uterine overdistension | Multiple gestation Hydramnios Macrosomic fetus |
Chorioamnionitis | Prolonged rupture of membranes Fever | |
Muscle exhaustion | Prolonged and/or rapid labour High multiparity | |
TISSUE RETENTION (TISSUE, 10% incidence) | Placenta | Placenta accreta Previous uterine surgery |
Clots | ||
BIRTH CANAL INJURY (TRAUMA, 20% incidence) | Tears in the birth canal | Instrumental delivery Precipitous second stage |
Uterine rupture or dehiscence | Previous uterine surgery (cesarean section) Instrumental delivery Dystocia Hyperactivity External cephalic version | |
Uterine inversion | Manual removal of the placenta Placenta accreta Credé maneuver | |
COAGULATION DISORDERS (THROMBIN, 1% incidence) | Acquired | Preeclampsia HELLP syndrome Disseminated intravascular coagulation (DIC) Amniotic fluid embolism Sepsis Placental abruption |
Congenital | Von Willebrand disease Hemophilia type A |