Abnormalities of the Third Stage of Labor

Question 1

What is the Obstetrics Trifecta

Answer 1

Hemorrhage
Hypertension
Infection

Question 2

Postpartum hemorrhage is defined by the ACOG as blood loss of ____ liter/s with signs and symptoms of hypovolemia

Answer 2

> 1 liter

Question 3

Postpartum hemorrhage is also defined as blood loss of _____mL in the first 24 hours after delivery

Answer 3

> 500mL

Question 4

Postpartum hemorrhage is considered if there is ___% decrease in hemoglobin and hematocrit level from baseline which is established prior to delivery

Answer 4

10%

Question 5

What is the treacherous feature of postpartum hemorrhage?

Answer 5

failure of pulse rate and blood pressure to undergo more than moderate alteration until large amounts of blood has been lost

Question 6

What is the percent blood loss if the estimated volume of blood loss is 500-1000?

Answer 6

10-15%

Question 7

What is the estimated volume and percent of blood loss if heart rate is >140 bpm?

Answer 7

2000-3000 mL
34-45%

Question 8

What are the usual signs and symptoms of blood loss causing SBP to fall to 60-80 mmHg?

Answer 8

Anuria
Altered consciousness

Question 9

If the SBP falls to 80-100mmHg, what is the estimated volume and percentage of blood loss?

Answer 9

1500-2000 mL
25-35%

Question 10

What is the estimated HR if the patient manifests pallor, oliguria, and restlessness due to blood loss?

Answer 10

120-140bpm

Question 11

What is the estimated volume and percentage of blood loss in a patient manifesting with extreme thirst and sweating?

Answer 11

1000-1500mL
15-25%

Question 12

This is defined as excessive bleeding after 24 hours of delivery

Answer 12

Late postpartum hemorrhage

Question 13

What are the 3 special conditions predisposing to hemorrhage due to BASELINE BLOOD VOLUME?

Answer 13

Small women (<5ft)
Severe Pre-eclampsia/Eclampsia
Chronic Renal Failure

Question 14

What are the pathophysiological mechanisms aggravating hypovolemic shock in patients with preeclampsia?

Answer 14

Generalized vasoconstriction of the body
Small increase in blood volume

Question 15

What are the 3 mains steps to prompt recognition and treatment of Postpartum hemorrhage?

Answer 15

ABC
Assessment
Breathing
Circulation

Question 16

What are the things to do when managing Circulation in a patient with postpartum hemorrhage?

Answer 16

Secure at least 1 line IV access for emergency purposes
Maintain adequate circulating blood volume through crystalloids and blood products

Question 17

What are the 4 Major risk factors for Postpartum Hemorrhage (PPH)?

Answer 17

Tone
Tissue
Trauma
Thrombin

Question 18

The presence of boggy and soft uterus and several cupsful amounts of blood clots after delivery points to what condition?

Answer 18

Uterine atony

Question 19

What is the MOST FREQUENT CAUSE of obstetrical hemorrhage?

Answer 19

Uterine atony