PPH Flashcards
What is AMTSL? 3 components
1) Pitocin (10 U IM or diluted IV)
2) Uterine massage
3) Gentle cord traction with suprapubic pressure
What are the 4 T’s of PPH?
Tone (70%)
Trauma (20%) – lacerations, hematoma, uterine inversion
Tissue (10%) – retained products
Thrombin (<1%) – coagulopathy
Methylergonovine (Methergine) is contraindicated in patients with ___________
Carboprost (Hemabate) is contraindicated in patients with ___________
Methylergonovine (Methergine) is contraindicated in patients with HYPERTENSION
Carboprost (Hemabate) is contraindicated in patients with asthma or CKD
Pitocin, Methergine, Hemabate, Misoprostol, and TXA all treat what cause of PPH?
Uterine atony (Tone)
1st line uterotonic for PPH 2/2 atony
Pitocin (high dose)
Dosing of Pitocin (AMTSL vs PPH)
AMTSL: 10 U IM or diluted IV
PPH: 30 U per 500 mL IV continuous infusion (or additional 10 U IM)
ACOG says 10-40 U per 500-1000 mL IV continuous infusion
Dosing of Methergine
Methergine 0.2 mg IM Q2H
Dosing of Hemabate
Hemabate 0.25 mg IM Q15min (max dose 2 mg)
Dosing of misoprostol (for PPH)
Misoprostol 800 mcg PO/SL/rectal (one dose only)
Dosing of TXA
TXA 1 g IV over 10 min (within 3 hours of delivery), can repeat after 30 min (max dose 2 g)
Full dosing chart for uterotonic agents (except Pitocin)
1) Methergine 0.2 mg IM Q2H
2) Hemabate 0.25 mg IM Q15 min (max dose 2 mg)
3) Misoprostol 800 mcg PO/SL/rectal (1 dose only)
4) TXA 1 g IV over 10 min (w/in 3 hrs of delivery), can repeat after 30 min (max dose 2 g)
Evaluation and management for PPH: split up by cause of PPH
1) Tone: uterotonics, uterine massage
2) Trauma: inspection, repair lacs
3) Tissue: inspect placenta, manual extraction, curettage
4) Thrombin: Get labs, give FFP
For all causes: Bakri balloon, Jada, uterine artery embolization, hysterectomy
What labs should I get during a PPH?
Type & Cross, CBC, BMP, PT/PTT, fibrinogen
