Hemorrhage Flashcards
Which breech position is most common
Frank breech 50-70% most common
Increased perinatal mortality due to
Cord compression
Intracranial bleed
Asphyxia
What is induction of labor associate with
Higher risk of post partum hemorrhage
Frequently underestimated failure to
Failure to:
Initiate treatment quickly
Recognize risk factors
Estimate extent of blood loss
What are the goals
Maternal resuscitation Fetal delivery Removal of placenta Contraction of uterus Adequate UO 30% loss of volume b4 dec in BP Assess capillary refil along UO
What med is used to relax uterus
NTG 400-800 mcq SL or
50-125 mcq IV for internal podalic version
Sponges and blood 18in x 18in standard lap sponge 50% 75% 100% no dripping 100% dripping
50% = 25 ml
75% = 50 ml
100% = 75 no blood dripping
100 ml with blood dripping
Factor VII (rFVIIa) When to use it What's the dose
Use in hemophilia Off label use for OB bleed Major bleed source identified/controlled Given after 10-12 uPRBC, 6-10 uFFP Platelets >50,000; fibrinogen >50; temp >32; pH>7.2 Dose: 90 mcq/kg q3 hrs, max of 9 doses
Tranexamic acid
Decreased blood flow
Decreased bleeding duration
Decreased need for excessive Pitocin during c/s
Given slow IV
Placental implamantation in lower uterine segment b4 fetal presentation
Placenta previa = c/s
Complete 40%
Partial 30% or low lying
Marginal 30%
Placenta previa s/s
- Painless vaginal bleeding
- Bleeding augmented: unable to constrict and contract vessels
- Potentially emergent c/s
- Lg bore IVs
- T/S, T/C if actively bleeding
Anesthesia plan for placenta previa
Hemodynamically unstable
Copious blood loss—SHOCK
C/S - GA w/OET, 100% O2
Etomidate .2-.3 mg/kg or Ketamine .5-1mg/kg
RSI, lg IV, CVP, Foley
Replace blood w/blood and crystalloids
Warmer
Neonate may be asphyxiated, acidotic, hypovolemic
Anesthesia for stable placenta previa
SAB or epidural
Mag sulfate infusion can worsen hypotension ask if ok to turn off
What is placenta accreta
Placenta fails to separate from uterine wall
Invasive implamantation into uterine wall, bladder, bowel, etc
Chorionic villi attach to the myometrium without normal intervening decidua basalis
Placenta accreta
Treatment for placenta accreta
- C/S b4 35 weeks to decrease hemorrhage
- Balloon occlusion catheters placed in anterior division of internal iliac arteries (contraleteral). Inflated after umbilical cord is cut or occluded w/gelfoam
- c/s performed under epidural anesthesia or GA
- hysterectomy increta 3.6 L blood loss and 12L for percreta
Which placenta is more common to happen after previous c/s and previa
Placenta Accreta
What does conservative treatment leaving it in, for accreta puts pt at risk for
Infection
Bleeding
Fistula formation
Failure of placental absorption
Placenta abruption
When
Associated with
-Separation of normally implanted placenta after 20 weeks and b4 birth
-ass w: HTN, increased parity, uterine abnormalities, previous abruption , maternal cocaine use, trauma
1% of pregnancies
High risk with placenta abruption
IUGR, decidual necrosis, placental infarcts
12% perinatal mortality
What arteries are ruptured in placenta abruption
Spiral artery- hemorrhage and retro placental clot formation- extends- involves more vessels- presses on uterus- pushes amniotic fluid to maternal circulation
Which placenta
Painful bleeding and increased uterine activity
Painless bleeding; may be profuse
Placenta abruption: painful
Placenta previa: painless
What this the definite treatment of placenta abruptio
To empty the uterus; vaginal delivery is preferred if there is fetal demise
50% prenatal mortality
4L of blood can be concealed in the uterus
Abruptio placenta mild to mod
90%, diagnose by excluding placenta previa
Usually no hypotension, coagulopathy, fetal distress
Epidural or SAB OK
Vag, not common
