Hemorrhage Flashcards
Hemorrhage risk factors
Prolonged oxytocin use High parity Chorioamnionitis Multiple gestation Fibroids Polyhydramnios Anesthesia
Hemorrhagic shock
a life-threatening condition of circulatory failure, causing inadequate oxygen delivery to meet cellular metabolic needs and oxygen consumption requirements, producing cellular and tissue hypoxia
Massive transfusion
Three to four units of red blood cells over one hour or any four blood components in 30 minutes
Massive transfusion “lethal triad”
HCA Hypothermia Coagulopathy Acidosis
Hemorrhage preparation
Large-bore IV catheters Blood bank Hemorrhage care Labs
Misoprostol SE
600-1000mcg oral, rectum, sublingual x 1 N/V/D Transient fever Headache Shivering
Hemabate SE
0.25mg IM every 15 -90 min N/V/D Transient fever Headache Shivering Bronchospasm
Methergine SE
0.2mg IM every 2-4h N/V Severe HTN
B-Lynch method
1 ) A large Mayo needle with # 1 or 2 chromic catgut is used to enter and exit 3 cm below the anterior uterine incision and exit 3 cm above the uterine incision anteriorly 2) then looped over and around to the posterior uterine segment 3) insert a horizontal suture at the posterior lower segment of the uterus which allows you to cross to the other side of the uterus posteriorly 4) loop the suture over and around the uterus again 5) insert the suture 3 cm above and below the incision and tied securely with uterine compression
Uterine atony management
Empty bladder Bimanual pelvic exam Remove intrauterine clots Uterine massage Oxytocin plus second agent If unsuccessful then: Uterine tamponade Bakri balloon 300-500mL of saline
Cesarean hysterectomy indications
Uterine hemorrhage Infection Fibroids Cervical cancer Adnexal disease
When do you activate MTP?
Bleeding with increased risk EBL > 1500 with continued bleeding Unstable patient
Primary etiology of postpartum hemorrhage:
Uterine atony Lacerations Retained placenta Abnormally adherent placenta Defects of coagulation (DIC) Uterine inversion 4 T (tone, trauma, tissue, thrombin) Occurs in the first 24 hours postpartum
Secondary etiology of postpartum hemorrhage:
Subinvolution of placental site Retained products of conception Infection Inherited coagulation defect occurs 24 hours - 12 weeks postpartum
Definition of PPH
cumulative blood loss greater than or equal to 1000mL + signs of hypovolemia within 24 hours after the birth process
Oxytocin
10 units IM or 40 units in 1,000mL as continuous infusion. Water toxicity leading to hyponatremia if administered IV
Tranexamic acid
100mg/ml administer over 10 minutes IV
most effective if used within 3 hours after delivery
WOMAN trial
Population: pregnant women experiencing postpartum hemorrhage Intervention: tranxemic acid Control: placebo Outcome: need for hysterectomy or death Conclusion: decreased mortality but not hysterectomy
Uterine artery embolization
Use in a hemodynamically stable patient with slow bleeding and have failed less invasive therapy. Has a risk of infertility in next pregnancy. no increased risk in preterm birth, fetal growth restriction
