OB Hemorrhage

Question 1

Leading cause of maternal death?

Answer 1

Obstetric hemorrhage

Question 2

Definition of PPH?

Answer 2

Any delivery w/ >1000 mL of blood loss w/i 24 hrs of delivery

Question 3

QBL

Answer 3

Quantitative blood loss –> actual measurement

Question 4

Common causes of PPH

Answer 4

1. Uterine Atony
2. Placental Abruption
3. Placenta Previa
4. Placenta Accreta
5. Retained products
6. Uterine Inversion
7. Uterine Rupture
8. Amniotic Fluid Embolism
9. DIC
10. Lacerations

Question 5

Risk factors for uterine atony

Answer 5

1. Overdistention of uterus
2. Prolonged Labor
3. Oxy augmentation
4. Grand multip
5. Mag infusion
6. Fibroids
7. Volatile anesthesia

Question 6

What do you initially do in hemorrhage?

Answer 6

ABCs!!! –> establish vitals

• establish access
• get hemorrhage kit!

Question 7

Uterine atony Tx

Answer 7

Oxytocin - 0.3 U or infusion
Methergine - 0.2 mg IM
Carboprost - 0.25 mg IM
Cytotec - rectal, subL, buccal

Question 8

TXA in hemorrhage

Answer 8

they strengthen the clot….but the number of benefit wasn’t that great in developed countries

Question 9

When do you want a T&S before delivery/section?

Answer 9

• 3rd time c-section
• previa
• prior ab surgeries
• low starting Hgb
• multiple gestation
• TOLAC
• HELLP
• known coagulation disorder

Question 10

Interventions from obstetrician?

Answer 10

Uterine tamponade 
   - Bakri balloon
Surgical 
  - uterine artery ligation, B-Lynch sutures, hysterectomy
IR 
  - uterine artery embolization