Hemorrhage Flashcards
Define a compensated PPH?
<1000mL, (10-15%) with normal vital signs, normal or increased pulse pressure, urinary output is >/=30cc/hr and AxOx4
Define mild PPH
1000-1500 (15-30%), HR >100, pulse pressure is narrowed, resp rate 20-30/min & urinary output 20-30/hr.
Mental status: weakness, anxiety, agitation, and sweating
Define moderate PPH
1500-2000, (30-40%)
HR >/= 120
BP: Hypotension with narrowed pulse pressure
RR: 30-40
urinary output: 5-15mL/hr
Mental status: restless, pallor, confusion
Define severe PPH
> /=2000 (>/=40%)
HR: >/=140
BP: profound Hypotension with narrowed PP
RR: >40
UO: slight or anuria
Mental status: air hungry, lethargy, collapse
Management plan for a parturient with moderate to high RISK of PPH
- provide anticipatory guidance to woman, family, and hospital staff
- Order type and screen and cross-match blood if needed & place 16 to 18g IV
- Empty bladder frequently
- Consider pain mgmt methods that will support parturient if PPH does occur
- Administer uterotonic agent during anterior shoulder
- Maintain uterine massage after placental expulsion and closely monitor.
How is the 1st line therapy, Oxytocin (Pitocin) given (IV & IM route)
IV: 10-80U in (250 or 500cc) of NS or LR
IM: 10 U
What are the contraindications for & SE of oxytocin?
CI: hypersensitivity
SE: cramping & HYPOnatremia
ADE: hypotension and cardiac collapse if undiluted
Onset & duration of action of oxytocin
Onset: 2-3 mins, but effectiv in 15-30mins
Duration: 2-3 hours IF given IM
How can the 2nd line, Methylergonovine maleate (Methergine) given?
- 2mg IM, repeat in 5 mins, and q2-4 hours OR
0. 2mg PO TID for prophylaxis
CIs and SEs to methergine
CI: HTN, PEC (&causes vasospasm if given IV)
SE: cramping, N/V, HTN, seizure, headache
Onset of action, plasma peak concentration, and 1/2 life of methergine
Onset: 2-5mins
Plasma peak concentration: 20-30 mins
1/2 life: 3-4hrs
What does Methergine’s BBW say?
Don’t BF for first 12 hours of NBs life
How to give Carboprost tromethamine (Hemabate)–aka 15 methyl protaglandin F2a analogue
250mcg IM q15-90mins, up to 8 doses
CI & SE & BBW for Hemabate
CI: ashtma, cardiac, pulmonary, renal, or hepatic dz
SE: N/V/D, bronchospasm, HTN, pyrexia (common)
BBW: avoid BF for first 12 hours
Peak serum concentration of Hemabate
30 mins, but LESS effective than methergine
How to give Misoprostol (Cytotec)
sublingual: 600-800mcg (can give BID)
Rectum: 800-1000mcg x 1
SE of cytotec
N/V/D, abdominal pain, pyrexia
Onset of action, peak concetration (rectal and SL)
onset: 3-5mins
Peak SL: 30 mins
Peak rectal: 40-60 mins
How to give Dinoprostone (Prostin E2)?
20mg vaginal or rectal, may repeat every 2 hours
CI, SE, and BBW of Dinoprostone (Prostin E2)?
CI: Hypotension and cardiac dz
SE: N/V/D & pyrexia
BBW: ONLY use in hospital settings (??)
Onset of action of Dinoprostone (Prostin E2)?
10 mins (slower than others(
When and how to give Tranexamic acid (Cyklokapron)?
When other measures fail, give TXA, which inhibits fibrinolysis
1g in 10mL syringe –IV push over 1 min
Can be repeated after 30 mins
SE & ADE of tranexamic acid
Mild GI distress, potential risk of thrombosis
What’s the difference between primary and secondary PPH?
Primary, also known as “early,” PPH is defined as a PPH occurring the first 24 hours, while secondary (late) PPH occurs between 24 hours and 6 weeks PP
Incidence of PPH and % of maternal mortality attributed to PPH.
2-3% of all births will r/i a PPH (often r/t oxytocin use & c-section)
20% of maternal deaths are attributed to hemorrhage, and 1/2 of these are preventable.
PPH is the leading cause of maternal mortality in this nation.
Define PPH
Blood loss of 1000mL or more
OR
Blood loss that is accompanied by s/sx of hypovolemia within 24 hours of birth.
Signs and symptoms of uterine rupture
Loss of station Sharp, continuous pain Bleeding Hematuria FHR changes
T or F: dehiscence of uterine scar requires immediate surgery
False; it doesn’t involve the serosa layer and patients are typically asymptomatic
