Postpartum Bleeding and Infection Flashcards
Uterine atony risk factors
Precipitous labor
Multiparity
Twins
General anesthesia
Oxytocin use
Macrosomia
Hydramnios
Chorioamnionitis
Placenta previa risk factors
Prior C-section
Myomectomy
Maternal age >35
Previous D&C
What should you do if you discover placenta previa during 18-20 wga ultrasound?
Serial ultrasounds throughout pregnancy
Which uterotonic should not be used in patient with asthma?
Prostaglandin F2-alpha (carboprost tromethamine) - potent smooth muscle constrictor and bronchoconstrictor
Which uterotonic should not be used in patients with hypertension or pre-eclampsia?
Methylergonovine
What are the risk factors for uterine overdistension/uterine inversion?
Excessive traction on umbilical cord
Grand multiparity
Multiple gestation
Polyhydramnios
Morbidly adherent placenta
Macrosomia
Order of treatments for postpartum hemorrhage due to uterine atony
Uterotonics
B-Lynch stich
Hypogastric artery ligation
Cesarian hysterectomy
How should oxytocin be delivered?
Diluted with IV fluids - do not give as an IV push
When should uterine artery embolization be considered?
When uterine atony, retained placental products, and lacerations have been ruled out as sources of bleeding
What do US placental lakes finding suggest?
Morbidly adherent placenta/placenta accreta spectrum
Often seen with history of C/S
May require hysterectomy for uncontrolled bleeding
Delayed (48-72h) postpartum hemorrhage suggests what etiology?
Von Willebrand disease coagulopathy
Risk factors for placental abruption
HTN
Advanced maternal age
Cocaine
Alcohol
What is gold standard antibiotics following C/S?
Gentamicin (gram-negative) + clindamycin (anaerobes)
Postpartum endometritis is a clinical diagnosis, based on what signs and symptoms?
Fever +:
Uterine tenderness
Abnormal vaginal discharge or odor
Delay in rate of reduction of size of uterus
When should septic pelvic thrombophlebitis be suspected?
A diagnosis of exclusion, after abscess (via CT) has been ruled out
Antibiotics + anticoagulation
What RUQ infection does pregnancy put women at risk for?
Cholelithiasis and cholecystitis
What is the most common cause of fever on postpartum day 1?
Lungs - mostly due to general anesthesia and aspiration pneumonia
What is the order of interventions for postpartum uterine atony?
Uterine massage, high-dose oxytocin
Tranexamic acid (antifibrinolytic agent)
Carboprost tromethamine (Prostaglandin F2-alpha), methylergonovine
vWF synthesis is increased by what hormones?
Estrogen and thyroid hormone
What are the diagnostic means for vWD?
vWF antigen, vWF activity (ristocetin cofactor activity; ristocetin promotes platelet agglutination in presence of vWF), factor VIII levels
Describe progression of lochia after delivery
Rubra (dark/bright red blood with small clots) –> serosa (serosanguinous (pink), brownish (old blood)) –> alba (white/yellow, creamy, light quantity), which is up to 8 weeks
Carboprost
Second-line uterotonic - prostaglandin F2a analog
Misoprostol
Second-line uterotonic or induction of labor - prostaglandin E1 analog
