Postpartum Hemorrhage

Question 1

definition of PP hemorrhage? what % of births end in hemorrhage? maternal hemorrhage accounts for what %age of maternal deaths PN? how quickly can you bleed to death?

Answer 1

hemorrhage= blood loss greater than 500 ml (1 c= 240 mL)
5% of births end in hemorrhage
maternal deaths dt hemorrhage= 25%
can bleed to death in 7 mins

Question 2

18 risk factors for PP hemorrhage?

Answer 2

partial separation so uterus can't clamp down effectively
long labors
twins- uterine distension
polyhydramnios - uterine distension 
precipitous labor
full bladder
mismanagement of 3rd stage
abn placental placement
psychological factors
low Hgb (less than 10)
fibroids
chorioamionitis
grand multip
lacerations
anesthesia
forceps
light skin/hair
previous hemorrhage

Question 3

characteristics of a hemorrhage?

Answer 3

gushes
slow trickle of blood
firm uterus but bleeding
non-visible hemorrhage = rising fundus
bright red blood = artery ruptured, need immediate pressure then hospital for stitches
pelvic pain w/decreased BP w/ or w/o bleeding suggests hemorrhage

Question 4

what factors contribute to a mom’s ability to tolerate a hemorrhage?

Answer 4

quantity of blood loss
Hgb
own awareness
blood vol before
body wt

Question 5

first line tx of PP hemorrhage?

Answer 5

deliver the placenta!!

Question 6

naturopathic tx options for PP hemorrhage?

Answer 6

tell mom to stop bleeding- engage her
check placenta for completeness, if incomplete then do manual sweep or D and C
latch baby or nipple stimulation
Herbs: capsella, cinnamon/erigeron, leonorus, trillium, claviceps, gossypium
check for tears

Question 7

how to perform the 3 different types of uterine massages?

Answer 7

1. uterine massage: put 1 hand on top of fundus and press caudally to stimulate uterus to contract
2. bimanual compression: “squeeze” uterus externally b/w your 2 hands
3. internal bimanual compression: 1 hand inside vagina, 1 hand externally on superior edge of uterus, press hands towards e/o

Question 8

traditional methods to tx PP hemorrhage?

Answer 8

pitocin (1 cc IM)
methergine (one tonic contraction, C/I in HTN pts)
shock position: head down, legs up
IV push
oxygen
threaten hospital or transport
catheterize

Question 9

two prostaglandins you can give to stop hemorrhage?

Answer 9

cytotec (misprostil) $

hemabate (carboprost tromethamine) $$$

Question 10

definition of shock?

Answer 10

CV system fails to provide sufficient circulation to every part of the body and causes tissues to eventually die dt lack of O2
compensatory mech to save the brain

Question 11

3 ways the brain stays oxygenated during shock?

Answer 11

1. peripheral vasoconstriction
2. increased HR (more blood to brain)
3. increased respirations (more O2)

Question 12

3 parts of the CV system?

Answer 12

pump = heart
fluid = blood
pipes = vessels

Question 13

4 types of shock?

Answer 13

1. hypovolemic
2. cardiogenic
3. neurogenic/vasogenic
4. psychogenic

Question 14

describe hypovolemic shock

Answer 14

dt blood loss dt internal or external hemorrhage
main type in deliveries
dehydation dt sweating, diarrhea, vomiting

Question 15

describe cardiogenic shock

Answer 15

heart failure

Question 16

describe neurogenic/vasogenic shock

Answer 16

decreased vascular tone –> anaphylactic shock –> too much histamine –> vasorelaxation of PNS, mb dt sepsis, blood poisoning, bee sting, etc

Question 17

describe psychogenic shock

Answer 17

fainting dt vasorelaxation then vasoconstriction

Question 18

10 ssxs of shock?

Answer 18

restlessness
anxiety
spaciness
foreboding feeling
denial of problem
rapid, shallow resp rate
increased HR but weak and thready
increased BP early, decreased BP later 
decreased pulse pressure
skin clammy, cool, pale except in neurogenic shock where the skin will be warm and flushed 
N/V, dilated pupils

Question 19

what is mild shock? amount of blood loss? change in BP? change in HR? respiration rate?

Answer 19

loss of 15-30% of blood vol
decrease of 10 pts or more in systolic
increase of 10 pts or more in HR
mild tachypnea, rapid, shallow breathing

Question 20

how many cups of blood in the body in a non-PG woman? when PG?

Answer 20

non-PG: 12 c

PG: 15-18 c

Question 21

what is moderate shock? amount of blood loss? change in BP? change in HR? respiration rate? change in skin? change in pupils? change in alertness?

Answer 21

loss of 25-35% of blood vol
decreased BPE
increase of 30 pts or more in HR
tachypnea, tachycardia
cold, pale
dilated pupils
awake, oriented to some degree

Question 22

what is severe shock? impending what? close to what? with proper management what is the best possible outcome? proper management?

Answer 22

loss of more than 40% of blood vol
impending circulatory collapse
close to edge of brain damage and death
with proper management may be able to save
need to transport- likely to need transfusion!

Question 23

how to prevent shock w/blood loss?

Answer 23

Trendelenberg position
rehydrate w/electrolytes: 1 tsp salt, 1/2 tsp baking soda, 4 c H20 or start IV
oxygen
warm blankets (unless in neurogenic shock)
keep talking and keep her in the here and now

Question 24

4 complications of a hemorrhage?

Answer 24

transfusion
DIC
uterine artery embolization
hysterectomy