Obstetric Hemorrhage, Sepsis - Moulton Flashcards
How much blood (PRBCs) must I give to raise the Hgb by 1 and the Hct by 3?
1 unit (250-300 cc)
A pregnant patient is bleeding BEFORE birth. What must first be determined BEFORE using your fingers to examine?
Placenta previa (could rupture membranes with fingers)
Placental abruption, previa, uterine rupture – bleed when?
AFTER 20 weeks
Pain or no?
- Previa vs. Abruption
More common?
- Previa vs. Abruption
Previa - no
Abruption - yes
Abruption
Risk factors for placenta previa
- Over 35 years
- Multiparity
- Multiple gestations
- Prior previa
- Previous C-section
3 kinds of placenta previa
- Marginal (does NOT cover Os)
- Partial
- Complete
Most placenta previa’s diagnosed at 30 weeks will do what?
“Migrate” by 32-35 weeks
When/how are unresolved placenta previa’s delivered?
C-section – 36-37 weeks (BEFORE LABOR) WHEN fetal lungs are mature
Placenta percreta (through myometrium) – manage how?
C-section hysterectomy
Most common risk factor for placenta abruption
Maternal HTN
If external trauma to the pregnant abdomen occurs, when will abruption most likely occur?
Within 6 hours
***Sudden intense, painful bleeding after 20 weeks - most likely?
Will often see what on baby exam? Cervical exam if during labor?
Placenta abruption
Abnormal FHR
Regression of “station”
Abruption is the most common cause of ____ in pregnancy
DIC
- ***Chance of uterine rupture after…
- Low transverse uterine incision
- Classical/vertical incision (C-section, myomectomy)
1%
4-7%
Vasa previa
How to diagnose?
Unprotected fetal vessel passing over the cervical os
Acute vaginal bleeding, tachycardia followed by bradycardia
Postpartum hemorrhage/bleeding w/in first 24 hours…? (1)
24 hours to 12 weeks? (3)
Uterine atony (80%)
Sloughing of eschar, retained products, subinvolution of uterus
***Postpartum palpation reveals a “boggy uterus”, bleeding from vagina
Risk factors?
Uterine atony
- Overly large uterus (multiples, polyhydramnios)
- Abnormal labor
- Leiomyoma
- Mag. sulfate
***A patient has a complicated labor and is on oxytocin for a prolonged period of time. Risk? Why?
Postpartum uterine atony
Oversaturated receptors –> weak contraction later
Non-pharm management of uterine atony
Bimanual massage of uterus
2 drugs for uterine atony w/ contraindications
Other drugs?
Methylergonovine (Methergine) – HTN
15-methyl-PGF2a (Hemabate) – ASTHMA
Oxytocin, Dinoprostone, Misoprostol
Postpartum, develops respiratory distress, cyanosis, CV collapse, hemorrhage, coma
Treatment?
Prognosis?
Amniotic fluid embolism
Respiratory support, correct shock, replace clotting factors
BAD (80% death)
Puerperal sepsis - defined as what?
This is generally called what?
Fever over 100.4 AFTER the first 24 hours for 2+ days within the first 10 days
Endometritis
Puerperal sepsis - most common organisms
If aerobic?
Anaerobic cocci (Peptostrepto, Pepto, Strepto)
E. coli, Enterococci
Postpartum - fever, uterine tenderness on days 2-3 (+ chills, malaise, anorexia)…
Most likely Dx?
Treatment? Most common regimen?
If resistant to the above regimen, most likely bug? Treatment?
Puerperal sepsis (endometritis)
Antibiotics - Ampicillin + Gentamicin
B. fragilis – Clindamycin
***Postpartum - consistent fever that does not respond to antibiotics, patient does not feel super ill, no evidence of thrombosis anywhere…
Dx?
Treatment?
Deep septic pelvic vein thrombophlebitis
Heparin until fever is gone for 2 days
Postpartum - fever and abdominal pain within 1 week of delivery, pain localized to one side…
Dx?
Treatment?
Ovarian vein thrombophlebitis
Anti-coagulate for 6 weeks, repeat imaging
