Postpartum Hemorrhage Flashcards
what is the most common cause of postpartum hemorrhage?
uterine atony
What are risk factors for uterine atony?
precipitous labor, multiparity, general anesthesia, oxytocin use in labor, prolonged labor, macrosomia, hydramnios, twins, and chorioamnionitis
What are the risks for genital tract lacerations?
Precipitous labor, macrosomia, or who have instrument assisted delivery or manipulative delivery(breech, etc)
What is the most common etiology of uterine inversion?
excessive traction on umbilical cord during third stage of delivery
What are uterotonics?
used to increase uterine contractions and decrease uterine bleeding
what are used as uterotonics?
methergine(methylergonovine), prostaglandins, misoprostol and oxytocin
What is MOA of methergine(methylergonovine) and when is it contraindicated?
it is an ergot alkaloid, which is a smooth muscle constrictor; it is also a vasoconstrictive agent and should be withheld from women with hypertension and/or preeclampsia
What is prostaglandin E1(misoprostol) used for?
cervical ripening and labor inductoin; also a uterotonic frequently used for uterine atony although not FDA approved for this use
What is Prostaglandin E2(Dinoprost) used for and when is it contraindicated?
a vaginal or rectal suppository used for uterine atony; avoid in hypotensive patients and must be stored in freezer so must be thawed before use
What is prostaglandin F2-alpha(hemabate) used for and when should it be avoided?
IM injection that is potent smooth muscle constrictor used for uterine atony and should be avoided in asthmatic patients bc can cause bronchoconstriction; side effects are diarrhea, fever, tachycardia
What is the MOA of oxytocin?
binds to receptors on uterine myocytes causing contractions
How does uterine inversion present?
globular mass at introitus after delivery
How is postpartum hemorrhage defined?
500cc after vaginal delivery or >1000cc after cesarean delivery
What are the first steps in management of postpartum hemorrhage?
make sure uterus is well-contracted, there is no retained placental tissue and look for lacerations
When is uterine artery embolization considered?
after other sources of bleeding such as lacerations are ruled out
What is a B lunch suture?
used at time of laparotomy for uterine atony; has been shown to be effective in management of unresponsive uterine atony
what is placenta accreta?
abnormally firm attachment of placenta to uterine wall; risk increased in women with previous c section; it is serious complication leading to retained placenta and severe postpartum hemorrhage; “placental lakes” on ultrasound
Ligation of what pelvic vessels can lead to reduction in vascular pressure in the pelvis thus controlling hemorrhage?
uterine artery and internal iliac(hypogastric) ligation
Von Willebrands disease can present for the first time in a patient with ___.
Delayed postpartum hemorrhage. Not uncommon to start bleeding 48-72hrs after delivery.
What are some common findings in a patient with placental abruption?
vaginal bleeding accompanied by painful contractions and rapid progression of labor and finding of a clot on her placenta
Patients undergoing abruption can progress into ___.
DIC and may require aggressive resuscitation with blood products
