PPH Flashcards
PPH definition
- > 1000 or
- blood loss with symptomatic anemia with 24h delivery
Etiology of PPH
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)
Risk factors of PPH
none are predictive
Prevention of PPH
- active management of third stage of labor recommended (though data not concrete)
= Pitocin (IV or IM), methergine, porstaglandin, uterine massage, umbilical cord traction
Management of PPH
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
Oxytocin
- 10-40u/1000cc continuous infusion
- IM 10u
methergine
0.2mg IM q2-4h
CI with HTN, cardiovascular disease
SE n/v, HTN when given IV which is not recommended
15 methyl PGF
(hemabate)
0.25mg IM or intramyometrial q15-90m, max dose 8
CI: asthma
RCI: active hepatic, cardiovascular, pulmonary disease
misoprostol
600-1000mcg po, sublingual, or rectally x1 dose
TXA
not recommended ppx, but can be considered if above therapy fails
vascular ligation
O Leary sutures (uterine artery ligation)
Urtero-ovarian artery ligation
hypogastric artery ligation is rarely performed today
uterine compression
B-lynch #1 chromic (allows for rapid resorption and minimizes risk of bowel herniation through a persistent loop of suture
hysterectomy
total or supracervical
- with placenta accreta with blood transfusion
- uterine conservation with focal accreta generally not successful
- for uterine rupture
risk of accreta with previa according to CS
3%, 11%, 40%, 61%, and 67%
Uterine inversion management
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)