pp hemorrhage

Question 1

hemorrhage is defined as

Answer 1

blood loss >500ml

Question 2

maternal hemorrhage accounts for __% of maternal deaths perinatally

Answer 2

25

Question 3

one can bleed to death in __ minutes

Answer 3

7

Question 4

early pp hemorrhage is considered

Answer 4

in the 1st 24 hours

Question 5

late pp hemorrhage is

Answer 5

1 day to 6 weeks

Question 6

late pp hemorrhage is usually dt

Answer 6

retained fragments and pp infxn

Question 7

late pp hemorrhage is more likely to be complicated by

Answer 7

DIC

Question 8

RF for hemorrhage

Answer 8

partial separation
long labors
twins
polyhydramnios
precipitous labor-shock to baby
full bladder- decreases effort to uterine contractions
mismanagement of 3rd stage- fundal fiddling
abnormal placental placement
psychological
decreased Hgb
fibroids
chorioamnionitis
grand multip
lacerations
anesthesia/epidural- decrease muscular response
forceps- uterine trauma of lower segment
light skin/red hair
previous hemorrhage

Question 9

characteristics of hemorrhage

Answer 9

gushes
slow trickle
firm uterus but bleeding
non-visible hemorrhage-rising fundus, clots or gush comes out with pressure
bright red blood-artery ruptured
pelvic pain with decreased BP with or without bleeding

Question 10

what is the first line of treatment

Answer 10

assist delivery of placenta

most hemorrhages will abate with delivery of placenta

Question 11

treatment options

Answer 11

tell mom to stop bleeding- engage her
check placenta for completeness--->manual sweep or D&C
nipple stim
herbs
massage
pitocin
methergine
shock position
IV push
oxygen
threaten hospital transport
catheterize
cytotec or hemabate

Question 12

uterin massage

Answer 12

help the upper segment to contract: Put 1 hand on top of fundus and press caudally to stimulate uterus to contract

Question 13

bimanual compression

Answer 13

use 2 hands and with the uterus between the hands use an inner motion to stimulate uterus to contract

Question 14

internal bimanual compression

Answer 14

put 1 hand inside uterus with sterile glove and the other on top of the fundus squeezing the fundus between your 2 hands

Question 15

pitocin

Answer 15

causes irregular contractions, Onset: 3-5 minutes, lasts 1 hour;
Sig: 10 -20 units (1-2cc) IM usually vastus lateralis 10-40 units in 1000 cc IV fluid (D5W)

Question 16

methergine

Answer 16

causes one tetanic contraction Onset: 2-5 minutes, lasts 2-4 hours; Sig: 0.2 mg IM. * CI in hypertensive pts

Question 17

cytotec

Answer 17

misoprostil; Inexpensive, stable at room temp Dose: 4-10 100 mcg tablets bucally or rectally Onset: 5-15 minutes

Question 18

hemabate

Answer 18

carboprost tromethamine; expensive, must be refrigerated Dose: 250mcg deep IM injection; Onset: 15 minutes; Side Effects: Vomiting, diarrhea in 2/3 pts

Question 19

hypovolemic shock

Answer 19

Decreased blood volume dt internal or external hemorrhage

Main type in deliveries; dehydration-sweating, diarrhea, vomiting

Question 20

cardiogenic shock

Answer 20

heart failure

Question 21

neurogenic/vasogenic shock

Answer 21

Decreased vascular tone leads to anaphylactic shock which is an over-release of histamine which leads to vasorelaxation of PNS. Maybe dt sepsis, blood poisoning, bee sting, etc.

Question 22

psychogenic shock

Answer 22

Fainting dt vasorelaxation then vasoconstriction

Question 23

ssx shock

Answer 23

Restlessness
Anxiety
Spaciness
Foreboding feeling
Denial of problem
Rapid, shallow respiratory rate
Inc HR but weak and thready
Inc BP is early sx
Dec BP is late sx
BP-systolic < 80 or a change of 10 mm Hg from normal
Decrease pulse-pressure (distance between systolic/diastolic)
Skin clammy, cool, pale, except in neurogenic shock the skin is warm and flushed
N+V, pupils dilated

Question 24

mild shock

Answer 24

Loss of 15-30% of blood volume (3-4 cups)
A non-pregnant woman has 12 cups of blood in body, 15-18 in pregnant state
Decrease of 10 points or more in Systolic BP
Increase of 10 points or more in HR (pulse)
Mild tachypnea, rapid, shallow respiration

Question 25

moderate shock

Answer 25

``` Loss of 25-35% of blood volume (4-5 cups). Decreased BP Increase of 30 points or more in HR Tachypnea, tachycardia Cold, pale, dilated pupils Awake, oriented to some degree ```

Question 26

severe shock

Answer 26

``` Loss of more than 40% of blood volume (5-6 cups) Impending circulatory collapse Close to edge, brain damage, death With proper management may be saved Transport Transfusion likely ```

Question 27

shock prevetion

Answer 27

Trendelenberg position Rehydration with electrolytes-1 tsp salt, 1/2 tsp baking soda, 4 cups H2O OR start IV Oxygen Warm blankets (except in neurogenic shock) Keep talking and keep her here and now

Question 28

complications of hmorrhage

Answer 28

transfusion DIC uterine artery embolization hysterectomy

Question 29

angelica archangelica

Answer 29

``` Helps with placental detachment Uterine stimulant Dose:Tincture 30-50 gtt s.l., repeat q 15 minutes Onset 5 minutes May also use Angelica sinensis ```

Question 30

capsella bursa

Answer 30

Promotes clotting Vasoconstrictor Promotes uterine contractions Dose:Tincture 20-40gtt under tongue for acute bleed 30gtt tid p.o. for subinvolution/chronic heavy bleeding

Question 31

cinnamomum zeylanicum

Answer 31

Assists placental detachment Hemostatic Restores uterine tone Dose: Tincture - 5-30 gtt sublingual

Question 32

erigeron canadensis

Answer 32

``` Passive bleeding Uterine atony Oil is oxytocic Dose: Tincture - 10-20 gtt Oil - 2-6 gtt no more than hourly ```

Question 33

cinnamon/erigeron oil

Answer 33

Good in combination Good shelf life 1 dram each in 14 oz EtOH Dose: 10-30 gtt in water

Question 34

claviceps purpurea

Answer 34

Oxytocic Increases blood pressure Dose:Powder - 8 grains; Tincture - 30 gtt

Question 35

gossypium herbaceum

Answer 35

Promotes expulsion of placenta/oxytocic Hemostatic Get organic! Dose:Tincture - 10-60gtt; Powder - 5-60 grains; Fluid extract - 1/2 -1 dr

Question 36

hamemelis viginiana

Answer 36

Hemostatic Astringent Does not close down os Dose: Tincture - 30-60 gtt q 5 min prn

Question 37

hydrastis canadensis

Answer 37

Mild oxytocic Hemostatic Dose:Tincture - 1-4 dr; Fluid extract - 5-50 gtt; Powder - 10-40 grains

Question 38

myrica cerifera

Answer 38

Highly astringent | Used with capsella

Question 39

trillium pendulum

Answer 39

PP Hemorrhage Prolapse Dose:Tincture- 30 drops q 5 – 15 minutes x 4 doses

Question 40

ustilago maydis

Answer 40

Oxytocic Gentler than ergot Dose: Tincture - 5-25 gtt

Question 41

viscum

Answer 41

Oxytocic Lowers blood pressure Dose: Tincture - 5-60 gtt q 15 minutes prn x 1hr; Fluid extract - 25-60 gtt; Powder - 10-25 grains

Question 42

ipecacuanha

Answer 42

``` Active pp hemorrhage - < lying down No clots Nausea – Severe, persistent Vomiting Dyspnea Cutting pain around navel ```

Question 43

arnica montana

Answer 43

``` Used routinely after birth to: Prevents hemorrhage Bruised feeling after delivery Instrumentation Shock due to excess bleeding Indications: Hot head Cool body Denies problem ```

Question 44

phosphorus

Answer 44

``` Active pp hemorrhage Bright red free-flowing, persistent Chilly Thirsty for ice cold drinks Sense of weakness across abdomen Fearful at sight of blood Easily reassured ```

Question 45

sabina

Answer 45

``` Active pp hemorrhage esp dt retained parts partly clotted possibly offensive blood Bright red Worse least movement Pain extending from sacrum to pubes ```

Question 46

trillium

Answer 46

``` Active pp hemorrhage Blood in gushes Worse least motion Pubic pain as if split through to sacrum Better from pressure on hips Bleeds after every birth, Hx of heavy menses ```

Question 47

china

Answer 47

``` Passive pp hemorrhage Brownish blood Large blood loss Tinnitus Pallor Cold sweat Yawning ```

Question 48

crotalus horridus

Answer 48

Passive pp hemorrhage No clots Blood black like meconium

Question 49

erigeron

Answer 49

Passive pp hemorrhage Gushes intermittently < slight exertion With painful urination

Question 50

ferrum

Answer 50

Passive pp hemorrhage Anemia but flushed face Pale, dark or black flow mixed with clots Fiery red face

Question 51

hamemelis

Answer 51

``` Passive pp hemorrhage Slow, steady, profuse, Dark blood mb dt anemia Pt shows no alarm or anxiety No uterine pain Pains bearing down the back Headache ```

Question 52

aconite

Answer 52

Passive or active Fear of death Restless Anxious

Question 53

belladonna

Answer 53

``` Bright red, hot blood With clots Hot face and head Full, pounding pulse Worse jarring, light, motion, and noise Retained placenta with infxn ```

Question 54

bryonia

Answer 54

``` Faintness from raising head Worse slight motion Headache Dryness of mucous membranes Irritability ```

Question 55

carbo-veg

Answer 55

``` Slow, passive hemorrhage Pale, cold Cold sweat and breath Wants to be fanned (air hunger) Pronounced weakness Poor muscle tone ```

Question 56

caulophyllum

Answer 56

``` Bleeding dt uterine exhaustion Soft, flabby uterus After prolonged, dysfunctional labor After precipitous labor Pains extending to the groin ```

Question 57

chamomile

Answer 57

Clots Snappy Uncivil

Question 58

cinnamon

Answer 58

Profuse Bright red Flooding Use with subinvolution in the days following the birth

Question 59

crocus sativa

Answer 59

Blood forming long, black tenacious strings hanging from vagina < straining, valsalva

Question 60

lachesis

Answer 60

Will not coagulate Suspicious Worse heat Nipples erect and sensitive

Question 61

secale cornutum

Answer 61

``` Dark, liquid blood, seldom clots Offensive Painless Chilly but desires to be uncovered Perception of heat Best for late pp hemorrhage which will not stop ```