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DM2 Prep- Obstetrics > Antepartum + Postpartum Haemorrhage > Flashcards

Antepartum + Postpartum Haemorrhage Flashcards

1
Q

Dose of oxytocin post vaginal delivery

A

10iu intrasmuscularly

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2
Q

Dose of oxytocin after cesarean section

A

5iu intravenous slow push

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3
Q

What is the definition of minor PPH

A

EBL 500- 1000L without clinical shock

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4
Q

Management of minor PPH (5)

A
  • one 14G iva
  • 20ml blood for cbc, gxm, coagulation, fibrinogen
  • vitals every 15minutes
  • warmed crystalloids
  • uterotonics
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5
Q

Definition of major PPH

A
  • EBL >1L
  • ongoing bleeding
  • or clinical shock
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6
Q

Management of Major PPH (10)

A
  • HELP
  • ABC
  • 2 large bore iva - cbc,u+e,pt/ptt,fibrinogen,gxm
  • Temperature q 15mins, continuous pulse,resp,bp monitoring charted on MEOWS
  • Foley catheter for I/O
  • Flat position
  • Warm
  • Transfuse ASAP(clinically determined)
  • rapid 3.5L warmes clear fluids until blood available
  • HDU level care
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7
Q

When and how is FFP administered

A

-If no coagulation panel available
- after each 4 units of blood

Rate: 12-15ml/kg until results available

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8
Q

Target fibrinogen level

A

> 2g/l

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9
Q

What should be used to replace fibrinogen?
Cryoprecipitate or FFP

A

Cryoprecipitate

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10
Q

What value of platelets require transfusion

A

<75 × 10e9/l

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11
Q

Definition of secondary PPH

A

Significant uterine bleeding between 24hrs and 12 weeks postpartum.

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12
Q

Initial evaluation of secondary PPH

A
  • HVS and endocervical swab
  • Ultrasound if patient haemodynamicallt stable
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13
Q

What is the further classification of Major PPH

A

Moderate 1001- 2000ml
Severe >2000ml

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14
Q

Therapeutic target in PPH (4)

A
  • Hb >8g/l
  • Platelet >50 x 10e9
  • PT/PTT less than 1.5 times normal
  • Fibrinogen >2g/l
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15
Q

Obstetric shock index

A

Tool used to clinically asses patients with obstetric hemorrhage and the risk of adverse outcomes

HR/SBP

score >/=1 associated with adverse outcomes

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16
Q

What is the rule of 30 (6)

A

Clinical red flag signs associated with severe hemorrhage

  • respiratory rate >30
  • pulse rate increase by 30bpm
  • fall in systolic bp of 30mmhg
  • hct fall >30%
  • urine output <30ml/hr
  • EBl 30% blood volume
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17
Q

Mechanical measures for management of PPH (2)

A
  • fundal massage
  • Foley catheter
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18
Q

Pharmacological management of initial pph (5)

A
  • 5uiv slow push oxytocin
  • ergometrine 5iu slow iv/I’m (htn)
  • oxytocin infusion 40iu in 500ml at 125ml/hr
  • carboprost 0.25mg I’m q 15mins max 8 doses (asthma)
  • misoprostol 800mcg sublingual
19
Q

Surgical interventions for pph
- first line

A

Intrauterine balloon

20
Q

What surgical measures to attempt post Balloon failure (5)

A

Laparotomy
Brace sutures- b lynch
Uterine artery ligation
Internal Iliac ligation
Hysterectomy

21
Q

Failure rate of BLYnch

A

25%

22
Q

Risk factors for B Lynch failure (3)

A
  • increased maternal age
  • vaginal delivery
  • delay if 2-6hrs between delivery and placement
23
Q

How many pregnancies are complicated by APH

A

3-5%

24
Q

Most predictive risk factor for placental abruption

A

Previous abruption

25
Q

What is the recurrence rate of placental abruption

A

4% after 1 abruption
25% after 2 previous abruptions

26
Q

What are other risk factors for placental abruption (maternal)
(6)

A
  • pre eclampsia
  • AMA
  • multiparity
  • ART
  • low bmi
  • smoking and cocaine
  • domestic abuse and trauma
27
Q

What are fetal causes of abruption(3)

A
  • malpresentation
  • polyhydramnios
  • FGR
28
Q

What are other risk factors beside maternal and fetal for placental abruption (2)

A
  • PPROM
  • intrauterine infection
29
Q

Risk factors for placental praevia (10)

A
  • previous placenta previa
  • previous cesarean section
  • previous top
  • uterine surgery
  • endometritis
  • AMA >40 yrs
  • ART
  • multiple pregnancy
  • smoking
  • multiparty
30
Q

Management of suspected DIC(pending coagulation screen)

A
  • up to 4units/1L FFP
  • up to 10 units/2 packs cryoprecipitate
31
Q

What is the odds ratio of recurrent placenta praevia

A

9.7

32
Q

Incidence of placenta praevia at term

A

1:200

33
Q

What is the rank of antepartum hemorrhage interms of direct maternal death

A

Sixth

34
Q

Diagnosis of vasa praevia

A
  • combination transabdominal and transvaginal colour doppler has best diagnostic accuracy
  • done at time of anomaly scan
  • may be diagnosed in labour after arom
35
Q

At what gestational age should patients with vasa praevia ve delivered

A
  • planned csection at 34-36 weeks I’d asymptomatic

Admit for corticosteroids at 32 weeks

36
Q

How is vasa praevia classified

A

Type 1 - velamentous attachment

Type 2- succenturiate or accessory lobe attachment

37
Q

What is the fetal mortality rate with ruptured vasa praevia

A

60%

38
Q

What is the survival rate of vasa praevia with antenatal diagnosis

A

95%

39
Q

What is the reported prevalence of vasa praevia

A

1: 1200 to 1: 5000

40
Q

What is the prevalence of vasa praevia following ivf

A

1:300

41
Q

What is the fetal blood volume at term

A

80 -100ml/kg

42
Q

Can vasa praevia resolve pre delivery?

A

Yes

20% of 2nd trimester vasa praevia resolve by t3 hence repeat ultrasound d at 32 weeks recommended

43
Q

What is the risk of placenta praevia after …
1 section
2 sections
3 sections
4 sections

A

1- 1:160 0.6% RR(nice) 4.5
2- 1:60 1.6% 7.4
3- 1:30 3.3% 6.5
4- 1:10 10% 44.9

DM2 Prep- Obstetrics (23 decks)

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