Hemorrhage

Question 1

Hemorrhage risk factors

Answer 1

Prolonged oxytocin use High parity Chorioamnionitis Multiple gestation Fibroids Polyhydramnios Anesthesia

Question 2

Hemorrhagic shock

Answer 2

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

Question 3

Massive transfusion

Answer 3

Three to four units of red blood cells over one hour or any four blood components in 30 minutes

Question 4

Massive transfusion “lethal triad”

Answer 4

HCA Hypothermia Coagulopathy Acidosis

Question 5

Hemorrhage preparation

Answer 5

Large-bore IV catheters Blood bank Hemorrhage care Labs

Question 6

Misoprostol SE

Answer 6

600-1000mcg oral, rectum, sublingual x 1 N/V/D Transient fever Headache Shivering

Question 7

Hemabate SE

Answer 7

0.25mg IM every 15 -90 min N/V/D Transient fever Headache Shivering Bronchospasm

Question 8

Methergine SE

Answer 8

0.2mg IM every 2-4h N/V Severe HTN

Question 9

B-Lynch method

Answer 9

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

Question 10

Uterine atony management

Answer 10

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

Question 11

Cesarean hysterectomy indications

Answer 11

Uterine hemorrhage Infection Fibroids Cervical cancer Adnexal disease

Question 12

When do you activate MTP?

Answer 12

Bleeding with increased risk EBL > 1500 with continued bleeding Unstable patient

Question 13

Primary etiology of postpartum hemorrhage:

Answer 13

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

Question 14

Secondary etiology of postpartum hemorrhage:

Answer 14

Subinvolution of placental site Retained products of conception Infection Inherited coagulation defect occurs 24 hours - 12 weeks postpartum

Question 15

Definition of PPH

Answer 15

cumulative blood loss greater than or equal to 1000mL + signs of hypovolemia within 24 hours after the birth process

Question 16

Oxytocin

Answer 16

10 units IM or 40 units in 1,000mL as continuous infusion. Water toxicity leading to hyponatremia if administered IV

Question 17

Tranexamic acid

Answer 17

100mg/ml administer over 10 minutes IV

most effective if used within 3 hours after delivery

Question 18

WOMAN trial

Answer 18

Population: pregnant women experiencing postpartum hemorrhage Intervention: tranxemic acid Control: placebo Outcome: need for hysterectomy or death Conclusion: decreased mortality but not hysterectomy

Question 19

Uterine artery embolization

Answer 19

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