22 - Hemostasis in Pregnancy

Question 1

coag factors inc and dec during pregnancy

Answer 1

inc: F 2, 7, 8, vWF, fibrinogen, d-dimer
dec: protein S

Question 2

pregnant women may look like they have this clotting factor deficiency

Answer 2

protein S

Question 3

effect of pregnancy of fibrinolysis

Answer 3

DEC fibrinolysis - inc fibrinolysis inhibitors

Question 4

strongest risk factor for thrombosis in pregnancy

Answer 4

personal history of thrombosis

Question 5

how long should you wait after pregnancy to assess normal thrombosis risk?

Answer 5

3 mo

Question 6

MC acquired thrombophilia in pregnancy

Answer 6

antiphospholipid syndrome (APS)

Question 7

post partum hemorrhage etiologies

Answer 7

4 Ts - tone (utine atony), trauma, tissue (retained products of conception/accreta), thrombin

Question 8

uterine atony

Answer 8

failure of uterus to contract after childbirth

use bimanual massage, uterotonics, uterine balloon tamponade

Question 9

MCC post partum hemorrhage

Answer 9

uterine atony

Question 10

vWD in pregnancy

Answer 10

hard to dx during - factors increase

2-3x risk of post partum hemorrhage, tend to present about 15 d later

Question 11

def of massive transfusion

Answer 11

10 units RBCs in 24 hrs, or 5 over 3

Question 12

“damage control” in massive transfusions

Answer 12

give 1:1:1 of blood products (plasma, platelets, RBCs)

Question 13

managing hyperfibrinolysis in pregnancy/delivery

Answer 13

antifibrinolytic drugs being tried now (aminocaproic acid)

replenish fibrinogen - cryo is best choice

Question 14

complications of massive transfusion

Answer 14

metabolic derangements
citrate tox > acidosis
hypocalcemia (citrate chelates it)
hyperkalemia (rapid infusion, stored blood > lysis)
hypothermia if not warmed products
transfusion reactions
fluid overload