Post-partum Hemorrhage Flashcards
PPH is defined as blood loss greater than
500 mL after vaginal birth
1000 mL after cesarean birth
major obstetric hemorrhage is defined as blood loss more than
1500mL to 2500mL
or bleeding that requires more than 5 units of transfused blood
blood loss that occurs within 24 hrs of birth is termed
primary (immediate or early) PPH
blood loss that occurs 24 hrs to 12 weeks after birth is termed
delayed (late) PPH
most common cause of PPH is
uterine atony
uterine atony means
- failure of uterus to contract and retract after birth (80% of PPH)
- obstetric lacerations, uterine inversion, and rupture (20% of all primary or early PPH)
uterus must remain _______ after birth to control bleeding from the placental site
contracted
during third stage of labour muscles of uterus contract downwards causing
constriction of blood vessels that pass through the uterine wall to the placental surface stopping the flow of blood
during pregnancy maternal blood volume increases as much as _____%
50%
because of the increase in maternal blood volume typical signs of hemorrhage do not appear until as much as ______ mL of blood has been lost
1800 to 2100 mL
typical hemorrhage signs include
- falling blood pressure
- increasing pulse
- decreasing urinary output
remember causes of PPH by using the 4 T’s
Tone - uterine atony, distended bladder
Tissue - retained placenta and clots, uterine subinvolution
Trauma - lacerations, hematoma, inversion, rupture
Thrombin - coagulopathy
Mild blood loss is ____%
Moderate blood loss is ____%
Severe blood loss is ____%
20%
20% - 40%
greater than 40%
S/S mild blood loss
- diaphoresis
- increased cap refill
- cool extremities
- maternal anxiety
S/S moderate blood loss
- tachycardia
- postural hypotension
- oliguria
altered tone of uterus most commonly results from
overdistention of the uterus
overdistention of the uterus is a major risk factor for
uterine atony
placental separation
failure of complete placental separation and expulsion leads to retained fragments, which occupy space and prevent the uterus from contracting fully to clamp down on blood vessels
placenta should be delivered within
30 mins - longer increases risk for PPH
uterine inversion happens when
top of uterus collapses into inner cavity due to excessive fundal pressure or pulling on the umbilical cord when placenta is still firmly attached to fundus after infant has been born
S/S of uterine rupture
- pain
- FHR abnormalities
- vaginal bleeding
active management of third stage of labour includes
- oxytocin administered
- cord clamping
- palpate fundus
- maintain tension of cord
- carbetocin
management of PPH includes
- ABCs
- IV crystalloid
- assess uterine fundus
- uterotonics and external massage
- empty bladder (catheter may be inserted)
- tranexamic acid
- bakri balloon
bakri balloon inflated to
put constant pressure on uterus
