post partum hemorrhage

Question 1

definition of post-partum hemorrhage

Answer 1

>500mL for vaginal delivery

>1000mL for Cesarean livery

Question 2

what is uterine atony?

Answer 2

lack of myometrial contraction, clinically manifested by a boggy uterus

Question 3

methylergonovine maleate - what is it?

Answer 3

an ergot alkaloid agent that induces myometrial contraction as a tx of uterine atony, C/I in hypertension

Question 4

prostaglanding compound that causes smooth muscle contraction that is C/I in asthmatic pts

Answer 4

prostaglandin F2-alpha

Question 5

what is the MCC of early post-partum hemorrhage?

Answer 5

uterine atony

Question 6

what is the management of post partum hemorrhage

Answer 6

1. uterine massage (bimanual compression w/an abdominal hand as well as vaginal hand) + **IV dilute oxytocin ** is given
2. if bleeding continues —>pharmacological uterotonic agents (ergot alkaloids, prostaglandin F2 alpha or misoprostol)
3. if cont. to bleed: two large bore IVs, foley catheter, call for blood, monitor vitals, move pt to OR intrauterine balloon or embolization if patient is stable.
4. if continued bleed, then laparotomy -

Question 7

other cause of PPH that if uterine is firm and contracted?

Answer 7

1. genital tract lacerations
2. uterus - uterine inversion
3. placental causes - placenta accret or retained placenta
4. coagulopathy

Question 8

what is late PPH? MCC

Answer 8

PPH occuring after 1st 24 hours and may be caused by involuation at the placental site.

MCC? retained products of conecption

Question 9

MCC of PPH?

Answer 9

uterine atony

Question 10

MCC of early PPH with well-contracted utersus?

Answer 10

genital tract lesion

Question 11

MCC of late postpartum hemorrhage (after 1st 24 hours)?

Answer 11

subinvolution of the uterus

Question 12

C/I for ergot alkaloids?

C/I for prostaglandin F2-alpha?

Answer 12

ergots - HTN

Prostaglandins - asthma

Question 13

eval and tx of PPH –> what should you do first?

Answer 13

1. stabilization of the circulatory status
2. address the hemorrhage

Question 14

how do you stabilize a patient with PPH?

Answer 14

address the ABCs

assure large bore IV infusion of isotonic crystalloid, assuring availability of blood products if needed and constantly monitoring key hemodynamic parameters

Question 15

etiology of PPH?

Answer 15

1. uterine atony
2. genital tract lacerations —>inspect to discern whether the bleeding is supracervical, cervical,or lower genital tract.