PPH

Question 1

What is the first vital sign change that will be seen with a PPH?

Answer 1

Heart rate will increase

Question 2

What percentage of maternal deaths are die to severe bleeding?

Answer 2

25%

Question 3

What percentage of deaths related to PPH are preventable?

Answer 3

54-93%

Question 4

How many women experience PPH?

Answer 4

1 in 20

Question 5

How much does maternal plasma volume expand during pregnancy?

Answer 5

42%

Question 6

What is the RBC increase for a pregnant woman?

Answer 6

24%

Question 7

Why are women who have a hx of hypertension at a higher risk for PPH?

Answer 7

they have a diminished maternal plasma volume expansion

Question 8

When will women begin to show signs of hypovolemic shock during a PPH?

Answer 8

After 1/3 of her blood volume is lost

Question 9

What is a frequent clinical error that causes late diagnosis of PPH?

Answer 9

not drawing Hct and Hgb levels soon enough

Question 10

What is the average blood loss for a vaginal delivery, cesarean delivery, elective cesarean hysterectomy, and an emergency hysterectomy, respectively?

Answer 10

Spontaneous vaginal delivery: 10% (500mL)
Cesarean delivery: 25% (1,000mL)
Elective cesarean hysterectomy: 33% (1,500mL)
Emergency hysterectomies: up to 75% (3,500mL)

Question 11

During a vaginal birth, what are reasons that the mother may experience the same amount of blood loss as a cesarean?

Answer 11

use of instruments (forceps, vacuum, or episiotomy) as well as having a 3rd or 4th degree laceration

Question 12

What percentage of NSVD and C/S, respectively, have a PPH?

Answer 12

4% and 6%

Question 13

When is primary PPH and when is secondary PPH?

Answer 13

less than 24 hours after delivery and after 24 hours after delivery

Question 14

What is the most common cause of PPH?

Answer 14

uterine atony

Question 15

What is the most common reason that uterine atony occurs?

Answer 15

Bladder distention

Question 16

What kind of drugs should be avoided in hypertensive women?

Answer 16

ergot alkaloids

Question 17

When should prostaglandins be contraindicated in a pregnant woman?

Answer 17

if a woman has reactive airway disease

Question 18

What are the drugs ordered when PPH is identified?

Answer 18

Oxytocin (Uterotonic), Methylergovine (uterotonic), Carboprost (Uterotonic), Dinoprostone, Misoprostol (prostaglandins)

Question 19

When would a slow trickle of blood be seen when a mother is postpartum?

Answer 19

if the mother has a laceration

Question 20

3 ways to manage stage the third stage of labor

Answer 20

20 units oxytocin, fundal massage, and gentle cord traction

Question 21

What are two uterotonics that are used to manage the third stage of labor?

Answer 21

Pitocin and carboprost

Question 22

How much blood is lost during a PPH?

Answer 22

> 1000mL or 10% total blood loss