OnlineMedEd: Obstetrics - "Post Partum Hemorrhage"

Question 1

Test questions will guide you to the cause of the postpartum hemorrhage by telling you the feel of the uterus on abdominal palpation. Go through the four possibilities.

Answer 1

• Absent: uterine inversion (when the uterus contracts so hard that it turns itself inside out)
• Boggy: uterine atony
• Firm: retained placenta
• Normal: vaginal laceration

Question 2

How is uterine inversion treated?

Answer 2

• First, use tocolytics to stop contractions
• Second, put it back in place manually
• Third, use tonics to get the uterus to contract back down

Question 3

How is uterine atony treated?

Answer 3

• First, massage

* Second, oxytocin, Methergine, Hemabate

Question 4

Retained placenta is treated by ____________.

Answer 4

D&C and (if that fails) hysterectomy

Question 5

Unexplained vaginal bleeds are treated much like _______________.

Answer 5

GI bleeds; because you can’t put pressure on either, you need to start two large bore IVs, administer fluids and blood, and then surgically find the laceration and fix it

Question 6

If you cannot find and correct the cause of the vaginal hemorrhage, the last resort options are _____________.

Answer 6

uterine artery ligation/embolization or total abdominal hysterectomy

Question 7

Uterine atony is when the uterine muscles fail to contract down. What things increase the risk of this happening?

Answer 7

• Prolonged labor (the uterus gets tired)
• Oxytocin (when you stop it, the uterus loses its input)
• Use of tocolytics (makes sense, right?(

Question 8

_______________ can raise the risk of uterine inversion.

Answer 8

Tonics and traction

Question 9

Retained placenta is diagnosed by _______________.

Answer 9

examining the placenta: if there are blood vessels that extend to the edge of the placenta, then there are likely pieces still inside the uterus that are causing hemorrhage