Post-Partum Hemorrhage Flashcards
postpartum hemorrhage (PPH) definition
500cc for vaginal
1000cc for c-section
what is the most common cause of postpartum hemorrhage
uterine atony
what is uterine atony
failure to contract uterus
what causes uterine atony
on oxytocin too long and receptors are saturated
contracting for too long
tocolytics
how will uterus feel if uterine atony
large and boggy
treatment of uterine atony
uterine massage
uterotonics (methylergonovine, oxytocin, carboprost, misoprostol vaginally)
mechanical tamponade (Bakri balloon or packing)
what uterotonic is contraindicated in asthma
carboprost
what uterotonic is contraindicated in HTN
methylergonovine
what is methylergonovine
smooth muscle constrictor that mostly acts on the uterus
what is carboprost
PGF2-α
what is uterine inversion
PPH + no palpable uterus
risks of PPH from uterine inversion
oxytocin use
umbilical cord traction
treatment of uterine inversion
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
risk for vaginal lacerations
precipitous deliveries or macrosomic babies
treatment of vaginal lacerations
local anesthesia and suture closed
what to look out for with vaginal lacerations
vaginal hematomas
- treatment is packing
- if become retroperitoneal, then surgery likely required
what are retained products of conception
parts of the membranes or placenta left behind in the uterus
- uterus will be firm
- can cause continued bleeding weeks after delivery
placenta accreta
placenta that has grown too deeply into the wall of the uterus
- in the endometrium, but not into the myometrium
placenta increta
burrows into the myometrium
placenta percreta
embeds through myometrium and uterine serosa
risk factors for placenta accretra/increta/percreta
increased number of pregnancy
treatment of retained products
dilation and curettage
if bleeding continues, hysterectomy
what is included in DIC panel
platelets
INR
fibrinogen
when to be concerned about fibrinogen
normally elevated in pregnancy
- DIC concern if low or ‘inappropriately normal’
treatment of DIC
packed red blood cells for low hemoglobin
platelets for low platelets
FFP for increased INR
cryoprecipitate for low fibrinogen
what to do with uncontrolled bleeding
operative control after all drugs fail
what to do for uncontrolled bleeding from vagina and uterus
cannot tamponade
IV access, fluid, and blood are important
how to approach operative control of PPH
uterine packing - help control bleeding source with mechanical pressure
- Bakri balloon can be placed
procedures to surgically control bleading
O'Leary sutures B-lynch compression suture box stitches hypogastric artery ligation uterine artery embolization hysterectomy
O’Leary sutures
around uterine arteries at level of internal os
B-lynch compression suture
on the uterus
box stitches
in the uterus to compress the muscle down
hypogastric artery ligation
ex-lap
uterine artery embolization
done in IR
hysterectomy
if everything else fails
what may be the first sign of bleeding that you cannot see?
hematoma
decreased urine output
how to handle unexplained bleeding
surgical ligation
hysterectomy
