PPH

Question 1

Define shock, and list three general etiologies for shock.

Answer 1

Shock: hypoperfusion of vital organs

May be cardiogenic, obstructive, septic, hypovolemic, or distributive.

Question 2

How are the following parameters affected in cases of moderate hemorrhagic shock (EBL 1.5-2 L):

HR
BP
Cap refill
RR
U/O
Mental status

Answer 2

HR > 120 bpm
Marked fall in BP
Cap refill usually delayed
Moderate tachypnea
U/O 5-20 mL/hr
Mental status: confused

Question 3

Give two definitions of PPH.

Answer 3

EBL > 500 mL in a vaginal delivery or > 1000 mL in a CS

or

Any amount of blood loss causing hemodynamic instability

Question 4

What effect do delayed cord clamping & cord traction have on the incidence of PPH?

Answer 4

None - cord traction shortens the third stage and decreases incidence of retained placenta, but has no effect on PPH overall

Question 5

List two contraindications to use of ergonovine for PPH.

Answer 5

Hypertension

Use of protease inhibitors or non-nucleoside reverse transcriptase inhibitors for HIV treatment

Question 6

List three alternatives to oxytocin for PPH prophylaxis.

Answer 6

Carbetocin (following cesarean section only)
Ergot (equally effective but more side effects)
Misoprostol (less effective but better than placebo)

Question 7

List three risk factors for retained placenta.

Answer 7

Previous retained placenta
Preterm delivery
Prolonged oxytocin use
Preeclampsia
2+ miscarriages or abortions

Question 8

List the first five treatments you would consider for PPH secondary to uterine atony.

Answer 8

External uterine massage
Oxytocin
Bimanual massage
Empty bladder
Additional oxytocin
Explore uterus to rule out retained products, rupture, inversion
Additional uterotonics (carboprost, misoprostol, ergonovine)
Tamponade with Bakri balloon or other balloon catheter