Obstetrical postpartum hemorrhage

Question 1

What is placenta accreta?

Answer 1

The placenta is adherent to the myometrium

Question 2

Placenta increta:

Answer 2

Placenta invades the myometrium

Question 3

Placenta percreta:

Answer 3

Placenta extends through the myometrium and may adhere to the surrounding structures

Question 4

Risk factors for placenta accreta and the others:

Answer 4

previous c section, current placenta previa

Question 5

Mgmt of the accretas: What will the surgeons do? What will you do?

Answer 5

arterial emboization under radiographic guidance
c hysterectomy.
I will ask for good IV access, art line, possible central line with CVP monitoring to help guide fluid therapy
Type and cross for at least 4 units of PRBCs
GA usually required for patient comfort and adequate operating conditions

Question 6

Uterine Atony: what are risk factors?

Answer 6

Pronlonged or rapid labor
Prolonged oxytocin use
Over distended uterus (fetal macrosomia)
placenta previa, mag sulfate, NTG

Question 7

KO Treatment plan for uterine atony:

Answer 7

Oxytocin (first line therapy; side effects: hypotension, nausea, emesis, water intoxication)
Prostaglandin hemabate/carboprost, contraindicated in patients with acti ve cardiac, renal, pulmonary, hepatic
Misoprostol: rectal or oral side effects: tachycardia and fever
Methergine: side effects: hypertension, nausea, vomiting-its a no in PET, pvd or ischemic heart disease

Question 8

When uterine atony is due a tocolytic therapy such as mg sulfate, treat with:

Answer 8

1 g of calcium gluconate IV

Question 9

uterine inversion: what are risk factors and how do you treat it?

Answer 9

uterine atony and overdistention, fetal macrosomia, prolonged labor, uterine malformaions are risk factors

KO tx plan: IV fluid therapy, uterine relaxation (mg, NTG), restore uterus to it’s normal position, and give pit once its in its rightful position. If this doesn’t work, you’ll have to do GA