1.7 Major Obstetric Haemorrhage

Question 1

Initial Assessment

2 hours post delivery

Answer 1

Airway:
Not patent / osbtructed
attempt basic
-> intubate + Ventilate

Breathing:
100% O2 NRB
Measure RR + Pulse Ox
Auscultate
ABG

Question 2

Initially assessment

Answer 2

C:
Establish 2 x wide bore
Take bloods

HR NIBP CRT
IV Fluids
Catheter

?O-ve if x match delayed

D
access GCS
<8/15 - Intubate

Invx
Recent bloods

Question 3

Surgical methods Rx MOH

Answer 3

1. Vigorous bimanual uterine massage
2. Aortic Compression
3. MROP
4. Repair ruptured uterus
   lacerated wall / cervix
5. Lap’omy + Uterine compression
   Replace if inversion
6. Haemostatic suturing
   B-Lynch
7. Tamponade balloon insertion
8. Bilateral ligation of uterine or IIA
9. Hysterectomy

Question 4

Non surgical methods

Answer 4

1. Uterotonic ladder
2. Blood products
3. Calcium replacement
   citrate chelation in MTP
4. Antifibrinolytics
   TXA 1g IV
5. Rad
   Uterine artery embolization

Question 5

Uterotonic Ladder

Answer 5

1. IV synto
5-10u slow bolus
\+- infusion 40iu in 500mls NaCl
100-125ml/hr
Caution - bolus ?hypotension / tachycardia

2 IV / IM Ergo
250-500mcg
nausea
Vom
Htn
Avoid PET

3. IM Haemabate / Methylprostoglandin F2a
4. 25-0.5mg

15min intervals
to max 5 doses

4. PR misoprostol 800mcg - 1mg

Question 6

2. Blood products

Answer 6

Packed red cell
improve HB conc

FFP
if PT/APTT >1.5

Plts
If <50

Cryo
Fib <0.5g/L

Novo seven (recomb factor VIIa)
100mcgkg
consider if:
corrected PT APTT Plt Fib
pH>7.2 and temp >36