Postpartum Hemorrhage

Question 1

What is the is the leading cause of maternal mortality worldwide?

Answer 1

PPH

Question 2

What is the term for when the placenta detaches from the uterus prematurely that result in fetal death?

Answer 2

Placental abruption

Question 3

Presentation of this condition is painful vaginal bleeding in association with uterine tenderness, hyperactivity; fetal distress, and increased uterine tone?

Answer 3

Placenta abruption

Question 4

What is the management for placental abruption and what should you never give in a patient wit this condition?

Answer 4

Use 16-18 gauge IV line for blood transfusion; *Give RBC liberally

NEVER give tocolytics or anything that will relax the uterus because it can cause more bleeding

Question 5

This condition is defined as a covering of the cervical os or opening?

Answer 5

Placenta previa

Question 6

What are the three types of placenta previa?

Answer 6

1. Complete: covers entire opening
2. Partial: covers part or half of the opening
3. Marginal: just at the edge of the os and not yet covering anything

Question 7

This condition can be asymptomatic or present with painless vaginal bleeding in 3rd trimester (around 30 weeks) & is the cause of 20% of antepartum hemorrhages?

Answer 7

Placenta previa

Question 8

How can you prevent placenta previa?

Answer 8

Don’t smoke or use cocaine. Period. That’s what the book says, that’s what Google says.

Question 9

If a patient is diagnosed with placental previa and makes it to 36 weeks without serious complications, what is the appropriate test t o assess fetal growth and what are the next steps?

Answer 9

• Use US to evaluate fetal lung maturity (can it survive out of the womb)
• If lungs are okay, preform caesarian section and deliver fetus

Question 10

What is the preferred delivery method in a case of placenta previa and why?

Answer 10

C-section because having/waiting for a spontaneous birth puts mama at risk for hypovolemia and anemia

Question 11

If a patient is suffering from placenta previa and has uncontrolled bleeding, what is the appropriate treatment?

Answer 11

Immediate delivery no matter the fetal age because mama could die due to hemorrhage

Question 12

What is the main cause for postpartum hemorrhage at 75-80%?

Answer 12

Uterine atony, which is failure of the uterus to contract and clamp placental blood vessels closed after placental separation

Question 13

What are the normal levels of blood loss in vaginal and caesarian births?

Answer 13

Vagina; <500mL
C-section <1000mL

Question 14

The first 3-4 days postpartum includes what type of bleeding and associated sx?

Answer 14

• Bleed like a heavy period
• can have small clots
• Blood is bright red or dark red
• can have period like cramps

Question 15

Days 4-10 postpartum include what type of bleeding and sx?

Answer 15

• pinkish brown discharge that’s less bloody or watery
• less or no clots
• moderate amount of flow

Question 16

What type of bleeding/discharge is expected between 12 days and 6 weeks postpartum?

Answer 16

• yellow/white discharge
• little to no blood
• light flow with some spotting; no clots

Question 17

What is abnormal attachment of placenta superficially to uterus?

Answer 17

Placenta accrete

Question 18

What is abnormal attachment of placenta into the myometrium?

Answer 18

Placenta increta

Question 19

What is abnormal attachment of placenta through the uterine serosa?

Answer 19

Placenta percreta

Question 20

What is the best management for placenta accrete/increta/percreta? What is a complication and possible requirement?

Answer 20

Removing the placenta
Complication: hemorrhage
Requirement: hysterectomy

Question 21

What are the 4 things that can be done to stop PPH?

Answer 21

1. Bimanual massage or compression
2. Uterine packing
3. IV Oxytocin (or other drug)
4. Surgery