Postpartum hemorrhage Flashcards
What is hemabate?
Carboprost tromethamine (15 methyl-PGF2alpha) - prostaglandin E2 receptor agonist.
Dose is 0.25mg q15 min x 8 doses max
What is methergine?
Ergot alkaloids are serotonergic receptor agonists in smooth muscle, weak antagonists of dopaminergic receptors, and partial agonists of alpha-adrenergic receptors. They induce fast rhythmic uterine contractions
dose is 0.2mg IM q2 hours
What is misoprostol?
prostaglandin E1, no contraindications
What is TXA?
anti-fibrinolytic, 1g IV, best when used within 3 hours of delivery
What are types of transfusion reactions?
Simple febrile: 1% risk. Use leuko-reduced products. Reaction against donor leukocytes. Self-limited, give tylenol
Allergic reaction: 0.2% of RBC. allergy to plasma protein, tx anti-histamine, continue transfusion
Anaphylactic: 1/20,000: tx epi IM
Hemolytic: very rare. Recipient antibodies induce hemolysis of donor RBC, due to ABO incompatibility. High mortality. Induces DIC. stop transfusion, support renal function, give iVF
TRALI: recipient neutrophil has anti-HLA affecting pulm vasculature. Find the donor bc can lead to TRALI in other recipients! That donor cannot donate again.
What are causes of PPH?
Atony, lacerations, retained products, uterine inversion.
What increases the risk of PPH?
Multiparity, hx PPH, multiple gestation, prolonged labor, macrosomia, chorio, use of magnesium
What is a PPH?
EBL>1L or signs/symptoms of hypovolemia within the first 24hrs of delivery.
Confirm that you have a type and cross. Initial management: empty bladder, uterine massage, pitocin
What are second line things to do in PPH if uterotonics aren’t helping?
UAE, bilateral uterine artery ligation. B-lynch (2-0 chromic), hysterectomy
When to active MTP?
EBL >1500cc, continued bleeding, unstable vital signs, suspect DIC.
