Beckman PPH

Question 1

PPH by mL:

Answer 1

> 500mL (vaginal) or

>1000mL (c-section)

Question 2

defining clinical hemorrhage

Answer 2

10% drop in hematocrit, need for transfusion, sxs of blood loss

Question 3

primary vs secondary pph

Answer 3

Primary: within 24 hrs
Secondary: btwn 24hrs - 12 weeks

Question 4

What will you see once blood loss approaches 20%?

Answer 4

First signs of intravascular depletion = tachycardia, tachypnea, delayed capillary refill, orthostatic changes, narrowed pulse pressure

Question 5

what prevents excessive bleeding from the placental implantation site?

Answer 5

uterine (muscular) contraction. loss of this = atony = PPH.

…so NOT coagulation

Question 6

conditions predisposing to atony

Answer 6

Enlargment of the uterus (hydramnios and multiple fetuses), abnormla labor (i.e. prolonged or augmented by pit), uterine leiomyomata, magnesium sulfate

Question 7

how do you dx uterine atony clinically

Answer 7

palapate softer, pliable/boggy uterus (instead of firm, contracted)

Question 8

Active mgmt of 3rd stage of labor (effect and mechanism)

Answer 8

reduces PPH by up to 70%. Pit infusion immediately following delivery. Note: immediate breastfeeding may also enhance uterine contractility and reduce blood loss

Question 9

Are uterotonic agents always effective?

Answer 9

No, only if there is atony. if the uterus is firm, won’t help.

Question 10

surgical mgmt of uterine atony

Answer 10

Uterine compression sutures (B-lynch. note: preserves fertility), sequential arterial ligation, selective arterial embolization, and hysterectomy

Question 11

sep of placenta from uterus occurs due to cleavage btwn:

Answer 11

zona basalis and zona spongiosa (facilitated by uterine contraction)

Question 12

Predisposing factors to retained placenta

Answer 12

Previous c/s, uterine leiomyomata, prior uterine curettage, accessory placental lobe

Question 13

Abnormal adherence of the placenta to the superficial lining of the uterus (with placental villi penetrating uterine wall)

Answer 13

placenta accreta

Question 14

penetration of placenta into the uterine muscle

Answer 14

placenta increta

Placenta percreta is complete invasion through the thickness of the uterine muscle

Question 15

hematomas <5cm mgmt?

Answer 15

If not enlarging, expectant mgmt. Keep checking size and monitor vitals, maybe use an ice pack

Question 16

Tx for hematoma at episiotomy site

Answer 16

remove sutures, find bleeding site and ligate. if not at episiotomy site, open and drain