Obstetric Flashcards
How is PPH defined?
As per WHO:
> 500mls/ 24 hours
severe = > 1000mls in 24 hours
Healthcare commission defines significant blood loss as > 1000 and severe loss as > 2500mls
What are the risk factors for major obstetric haemorrhage?
General Age > 35 Obesity Anaemia Asian
Obstetric: IOL Prolonged labour Para > 3 Placental abnormalities Twins Previous LSCS Previous MROP Previous myomectomy Pre-eclampsia Previous PPH Large baby Polyhydramnios
What is the most common cause of PPH?
Atony
the others are retained tissue, trauma and coagulopathy
What are the types of MOH?
PPH - most common Placental abruption Placenta praevia Placenta accreta Uterine rupture Ectopic pregnancy
What is placenta acreta?
Major or minor
Low lying placenta/covering the os
What is placenta accreta/increta/percreta?
Abnormal implantation of placenta
Accreta - abnormally adherant to the uterus
Increata - invades the myometrium
Percreta - through the uterus and into the peritoneal cavity
What are the principles of resuscitating a MOH?
Left lateral tilt Large bore IV access O2 IV fluid May need O neg blood Warm blood/fluid Correct coagulopathy - incl calcium Empty the bladder Treat underlying cause - atony/suture wounds/may need Bakri baloon/ B-lynch suture/embolectomy/hysterectomy Consider TXA
What are the drugs used to treat utrine atony?
Oxytocin
Ergometrine
Carboprost
Misoprostol
What is amniotic fluid embolism?
Rare, catastrophic obstetric emergency
It occurs when amniotic fluid or cells enter the maternal circulation
What is the incidence of AFE?
Between 1 and 12 per 100,000 deliveries
What are the pathogenic mechanisms of AFE?
2 phase immune response
1. Vasoactive substances are produced in response to feral tissue antigens resulting in pulmonary artery vasospasm leading to right heart failure, hypotension, and hypoxaemia. Can last 30 mins
2. RV recovers but LV failure and pulmonary oedema occur
Biochemical mediators and severe hypoxaemia lead to increased capillary permeability, DIC, uterine atony and massive haemorrhage
What are the clinical features of AFE?
Hypoxia Cardiovascular collapse Coagulopathy SOB Cyanosis Hypotension Dysrhythmias DIC
May present more subtlety with vomiting and anxiety
What are the risk factors for AFE?
Advanced maternal age Placental pathology IOL Operative delivery Multiparity Polyhydramnios Uterine rupture IUD Trauma eg cervical lacerations
How is AFE managed?
Early recognition and prompt resuscitation and expedited delivery of fetus
- Rapid IV filling and vasopressors
- left lateral tilt - Rapid delivery
- Activate major haemorrhage protocol
What’s the differential diagnosis of AFE?
Obstetric
- placental abruption
- eclampsia
- PPH
Non- obstetric
- anaphylaxis
- total spinal anaesthesia
- septic shock
- massive PE
