PPH Rowe 3

Question 1

What are the 4 underlying causes of PPH (4 Ts)?

Answer 1

Tone, Tissue, Trauma, and Thrombin

Question 2

Describe Tone:

Answer 2

overdistention, exhaustion or infection

Question 3

Describe tissue:

Answer 3

retained products of conception

Question 4

Describe trauma:

Answer 4

injury such as episiotomy extension, uterine rupture.

Question 5

Describe thrmobin:

Answer 5

pre-existing or acquired issues with coagulation (blood clotting) from ex pre-eclampsia

Question 6

What are meds reccomended for AMTSL?

Answer 6

Oxytocin
Carbetocin
Misoprostol
Ergonovine

Question 7

What is the first line med for AMTSL?

Answer 7

Oxytocin

Question 8

MOA of oxytocin?

Answer 8

uterotonic, direct stimulation of oxytocin receptors - stimulates uterine contraction

Question 9

List the 5 most common medications used for treatment of PPH

Answer 9

oxytocin
Ergonovine
Carboprost
Carbetocin
Misoprostol
Tranexamic acid

Question 10

Contraindications of oxytocin?

Answer 10

Hypersensitivity

Question 11

Adverse reactions of oxytocin?

Answer 11

Nausea, vomiting, painful contractions, severe water intocivation with convulsions, hemodynamic changes and ECG findings of MI if given too fast, high doses can result in uterine hypertonicity, tetanic contraction or rupture of the uterus

Question 12

Contraindications of ergonivine?

Answer 12

hypertension, preeclampsia, drug interactions (macrolides, HIV medications)

Question 13

Contraindications of carboprost?

Answer 13

asthma, active cardiac, pulmonary, renal, or hepatic disease

Question 14

Contraindications of Tranexamic acid?

Answer 14

Acute renal failure, thrombosis induced cortical necrosis

Question 15

Adverse reactions of ergonvine?

Answer 15

nausea, vomiting, shortness of breath, hypertension, arrhythmias, chest pain, ischemia, peripheral vasospasm

Question 16

Adverse reactions of carboprost?

Answer 16

anxiety, dizziness, drowsiness, bronchospasm, cough, pulmonary edema, chest pain, hypertension, tachycardia (not as severe cardiac effects so used if patient has cardiac abnormalities)

Question 17

Adverse reactions of Misoprostol?

Answer 17

fever, headache, nausea, vomiting, diarrhea, abdominal pain.

Question 18

Adverse reactions of Tranexamic acid?

Answer 18

blurred vision, changes in color, visual loss, hypotension (esp. if given too fast), nausea, vomiting, diarrhea, thrombosis

Question 19

Use of Ergonovine for PPH?

Answer 19

2nd line - give alongside tranexamic acid) (used for asthmatic clients

Question 20

Indication of use carboprost PPH?

Answer 20

2nd line - give alongside tranexamic acid; not used for active management) (used if client has cardia abnormalities)