Obstetric haemorrhage Flashcards
Define antepartum haemorrhage
Bleeding from genital tract from 24 weeks to before birth
Define primary postpartum haemorrhage
Loss of >500ml of blood from genital tract from birth to 24 hours
Define secondary postpartum haemorrhage
Loss of >500ml of blood from 24 hours to 12 weeks after birth
What physiological changes occur in pregnancy? (2)
Clotting (increase in fibrinogen and clotting factors) Blood loss (volume increases)
What clotting factors are increased in pregnancy? (6)
II, VII, VIII, X XI, XII
Draw out the table of classification of haemorrhagic shock!
Actually do this I know you’re putting it off
What are the 4 causes of obstetric haemorrhage? (4)
Tone
Trauma
Tissue
Thrombin
Give 2 examples for a tone cause of obstetric haemorrhage
Atonic bleeding
Prolonged labour
Over-distended uterus (twins, large baby, polyhydraminos)
Give 2 examples for a trauma cause of obstetric haemorrhage
Uterine (inverted uterus, ruptured uterus from caesarean scars, surgical damage) Genital tract (vaginal tears)
Give 2 examples for a tissue cause of obstetric haemorrhage
Placenta praevia
Placenta creta
Give 2 examples for a thrombin cause of obstetric haemorrhage
Congenital (VWD, haemophilia)
Acquired (sepsis, pre-eclampsia), abruption, HELLP syndrome, amniotic fluid embolus
Placental abnormalities (ITP, gestational thrombocytopenia, DIC)
Why may blood loss estimates be inaccurate?
HR and BP compensation
Amniotic fluid
What are 2 examples of uterotonic agents?
Syntocinon (oxytocin)
Ergometrine
Carboprost (PG)
Misoprostol (PG)
What non-uterotonic agent can be given to stop bleeding?
Transexaminc acid (antifibrinolytic)
Give 2 haematological managements of a haemorrhage
Saline transfusion (circulating volume) Blood transfusion (replace blood) Blood products (correct coagulation)
