Columbus & ACOG PB: obstetrical hemorrhage and transfusion Flashcards
What percentage of abruptions are associated with underlying hypertension?
50%
Among causes of hemorrhage related mortality, which is associated with the highest risk of maternal death?
Placental abruption, almost 20%
What is the incidence of abruption in Caucasians and African-Americans?
0.5%
What are risk factors for abruption?
Prior abruption, smoking, trauma, cocaine use, multiple gestation, hypertension, thrombophilia, advanced maternal age, PPROM, polyhydramnios
How does abruption clinically present?
Vaginal bleeding 80% Uterine tenderness 60% Tachysystole 20% Hypertonus 20% Stillbirth 15%
Describes the “30-30 rule” used to avoid acute kidney injury?
Aggressive treatment of hypovolemia to maintain hematocrit above 30% and urine output above 30 mL per hour
What lab testing should be performed for evaluation of abruption?
CBC, creatinine, PT/PTT, fibrinogen, type & screen
How long does fresh frozen plasma take to prepare?
What is the volume of fluid?
How much does one unit increase fibrinogen by?
What are the other contents?
30-40 minutes
250 mL
10 mg/dL
Antithrombin III, factors V & VIII
What is the volume of one unit of packed RBCs?
How much would this be expected to raise hemoglobin?
300 mL
1 g/dL or hematocrit by 3%
At what fibrinogen threshold should fresh frozen plasma be administered?
150 mg/dL
When should platelets be transfused?
What is the volume of one units?
How much would a six pack be expected to raise platelet count?
Platelet count less than 50,000 with clinical bleeding
50 mL
30,000 per microliter
What are the general principles of management of DIC?
Treat underlying cause
Restore circulating blood volume
Timely and appropriate use of blood products
No heparin or anti-fibrinolytics
What are causes of DIC in obstetrics?
Dilution from any cause of hemorrhage Abruption: 33% incidence if stillborn Amniotic fluid embolism Acute fatty liver Retained dead fetus greater than four weeks Sepsis or septic abortion Preeclampsia, eclampsia, HELLP syndrome
What is the most common cause of postpartum hemorrhage?
What are risk factors?
Uterine atony
Rapid or prolonged labor Over-distended uterus Oxytocin General anesthetic Chorioamnionitis High parity History of atony: 10% recurrence Hypotension from hemorrhage or regional anesthesia
How should uterine atony be initially managed?
Uterine massage or compression Oxytocin IV access Labs including CBC, coags, type and screen or crossmatch Methergine or Hemabate Foley