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Online Med Ed - Obstetrics > Post-Partum Hemorrhage > Flashcards

Post-Partum Hemorrhage Flashcards

1
Q

postpartum hemorrhage (PPH) definition

A

500cc for vaginal

1000cc for c-section

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2
Q

what is the most common cause of postpartum hemorrhage

A

uterine atony

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3
Q

what is uterine atony

A

failure to contract uterus

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4
Q

what causes uterine atony

A

on oxytocin too long and receptors are saturated
contracting for too long
tocolytics

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5
Q

how will uterus feel if uterine atony

A

large and boggy

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6
Q

treatment of uterine atony

A

uterine massage
uterotonics (methylergonovine, oxytocin, carboprost, misoprostol vaginally)
mechanical tamponade (Bakri balloon or packing)

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7
Q

what uterotonic is contraindicated in asthma

A

carboprost

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8
Q

what uterotonic is contraindicated in HTN

A

methylergonovine

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9
Q

what is methylergonovine

A

smooth muscle constrictor that mostly acts on the uterus

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10
Q

what is carboprost

A

PGF2-α

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11
Q

what is uterine inversion

A

PPH + no palpable uterus

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12
Q

risks of PPH from uterine inversion

A

oxytocin use

umbilical cord traction

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13
Q

treatment of uterine inversion

A

placing the uterus back where it belongs with bimanual exam
tocolytics may be needed to relax uterus into place
uterotonics may be needed to contract it down

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14
Q

risk for vaginal lacerations

A

precipitous deliveries or macrosomic babies

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15
Q

treatment of vaginal lacerations

A

local anesthesia and suture closed

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16
Q

what to look out for with vaginal lacerations

A

vaginal hematomas

  • treatment is packing
  • if become retroperitoneal, then surgery likely required
17
Q

what are retained products of conception

A

parts of the membranes or placenta left behind in the uterus

  • uterus will be firm
  • can cause continued bleeding weeks after delivery
18
Q

placenta accreta

A

placenta that has grown too deeply into the wall of the uterus
- in the endometrium, but not into the myometrium

19
Q

placenta increta

A

burrows into the myometrium

20
Q

placenta percreta

A

embeds through myometrium and uterine serosa

21
Q

risk factors for placenta accretra/increta/percreta

A

increased number of pregnancy

22
Q

treatment of retained products

A

dilation and curettage

if bleeding continues, hysterectomy

23
Q

what is included in DIC panel

A

platelets
INR
fibrinogen

24
Q

when to be concerned about fibrinogen

A

normally elevated in pregnancy

- DIC concern if low or ‘inappropriately normal’

25
Q

treatment of DIC

A

packed red blood cells for low hemoglobin
platelets for low platelets
FFP for increased INR
cryoprecipitate for low fibrinogen

26
Q

what to do with uncontrolled bleeding

A

operative control after all drugs fail

27
Q

what to do for uncontrolled bleeding from vagina and uterus

A

cannot tamponade

IV access, fluid, and blood are important

28
Q

how to approach operative control of PPH

A

uterine packing - help control bleeding source with mechanical pressure
- Bakri balloon can be placed

29
Q

procedures to surgically control bleading

A 
O'Leary sutures
B-lynch compression suture
box stitches
hypogastric artery ligation
uterine artery embolization
hysterectomy
30
Q

O’Leary sutures

A

around uterine arteries at level of internal os

31
Q

B-lynch compression suture

A

on the uterus

32
Q

box stitches

A

in the uterus to compress the muscle down

33
Q

hypogastric artery ligation

A

ex-lap

34
Q

uterine artery embolization

A

done in IR

35
Q

hysterectomy

A

if everything else fails

36
Q

what may be the first sign of bleeding that you cannot see?

A

hematoma

decreased urine output

37
Q

how to handle unexplained bleeding

A

surgical ligation

hysterectomy

Online Med Ed - Obstetrics (19 decks)

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