PPH Flashcards

1
Q

PPH definition

A
  • > 1000 or

- blood loss with symptomatic anemia with 24h delivery

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2
Q

Etiology of PPH

A
PRIMARY CAUSES
atony (most common)
lacerations
retained POC
accreta
DIC (associated with abruption and AFE (rare)
uterine inversion
SECONDARY CAUSES
placenta site subinvolution
ret POC
infection
inherited coagulapthy (vWD)
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3
Q

Risk factors of PPH

A

none are predictive

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4
Q

Prevention of PPH

A
  • active management of third stage of labor recommended (though data not concrete)
    = Pitocin (IV or IM), methergine, porstaglandin, uterine massage, umbilical cord traction
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5
Q

Management of PPH

A

1) uterine massage and bimanual compression + uterotonics
2) repair of lacerations and conservative or surgical treatment of hematoma
3) examination of placenta for retained POC (and manual vs banjo curette as indicated)
4) tamponade (manual compression, intrauterine packing, bark balloon, multiple foley ballon packing)
5) UAE (stable pts with continued bleeding)
6) surgery

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6
Q

Oxytocin

A
  • 10-40u/1000cc continuous infusion

- IM 10u

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7
Q

methergine

A

0.2mg IM q2-4h
CI with HTN, cardiovascular disease
SE n/v, HTN when given IV which is not recommended

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8
Q

15 methyl PGF

A

(hemabate)

0.25mg IM or intramyometrial q15-90m, max dose 8

CI: asthma
RCI: active hepatic, cardiovascular, pulmonary disease

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9
Q

misoprostol

A

600-1000mcg po, sublingual, or rectally x1 dose

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10
Q

TXA

A

not recommended ppx, but can be considered if above therapy fails

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11
Q

vascular ligation

A

O Leary sutures (uterine artery ligation)
Urtero-ovarian artery ligation
hypogastric artery ligation is rarely performed today

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12
Q

uterine compression

A

B-lynch #1 chromic (allows for rapid resorption and minimizes risk of bowel herniation through a persistent loop of suture

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13
Q

hysterectomy

A

total or supracervical

  • with placenta accreta with blood transfusion
  • uterine conservation with focal accreta generally not successful
  • for uterine rupture
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14
Q

risk of accreta with previa according to CS

A

3%, 11%, 40%, 61%, and 67%

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15
Q

Uterine inversion management

A

1) leave placenta attached to prevent further bleeding
2) give tocolytics
3) replace the inverted uterus (peripherally to centrally)
4) occasionally surgery is required:
- - Huntington procedure (serial clamping from above of the funds with allis clamp)
- - Haultian procedure (incising the cervix posteriorly to allow for reversion)

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16
Q

transfusion

A
  • give when hgb <7 and symptomatic, if asymptomatic then consider PRBC, oral or IV iron therapy
  • consider when EBL 1500 + hypovolemic vital signs
  • address hypovolemia and consumptive coagulpathy (hgb not a good marker in context of PPH)
  • Massive transfusion = >10u or >4u PRBC in 1h for ongoing need for more blood
  • MTP: 1:1:1 PRBC, FFP, Platelets
  • cryo added if have consumptive coagulopathy
17
Q

massive transfusion is associated with

A
  • HYPERkalemia
  • citrate toxicity (preservative in blood products)
  • HYPOcalcemia
  • Pulmonary edema (when associated with excessive crystalloid infusion, transfusion reactions, and transmission of various pathogens)
18
Q

Alternatives to transfusion

A
  • Cell salvage: seldom used
  • Thrombin complex and fibrinogen concentrates (only used after successive rounds of massive transfusion)
  • recombinant factor VII (controversial, only consider as a last resort)