PPH Rowe 3 Flashcards
What are the 4 underlying causes of PPH (4 Ts)?
Tone, Tissue, Trauma, and Thrombin
Describe Tone:
overdistention, exhaustion or infection
Describe tissue:
retained products of conception
Describe trauma:
injury such as episiotomy extension, uterine rupture.
Describe thrmobin:
pre-existing or acquired issues with coagulation (blood clotting) from ex pre-eclampsia
What are meds reccomended for AMTSL?
Oxytocin
Carbetocin
Misoprostol
Ergonovine
What is the first line med for AMTSL?
Oxytocin
MOA of oxytocin?
uterotonic, direct stimulation of oxytocin receptors - stimulates uterine contraction
List the 5 most common medications used for treatment of PPH
oxytocin
Ergonovine
Carboprost
Carbetocin
Misoprostol
Tranexamic acid
Contraindications of oxytocin?
Hypersensitivity
Adverse reactions of oxytocin?
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
Contraindications of ergonivine?
hypertension, preeclampsia, drug interactions (macrolides, HIV medications)
Contraindications of carboprost?
asthma, active cardiac, pulmonary, renal, or hepatic disease
Contraindications of Tranexamic acid?
Acute renal failure, thrombosis induced cortical necrosis
Adverse reactions of ergonvine?
nausea, vomiting, shortness of breath, hypertension, arrhythmias, chest pain, ischemia, peripheral vasospasm
Adverse reactions of carboprost?
anxiety, dizziness, drowsiness, bronchospasm, cough, pulmonary edema, chest pain, hypertension, tachycardia (not as severe cardiac effects so used if patient has cardiac abnormalities)
Adverse reactions of Misoprostol?
fever, headache, nausea, vomiting, diarrhea, abdominal pain.
Adverse reactions of Tranexamic acid?
blurred vision, changes in color, visual loss, hypotension (esp. if given too fast), nausea, vomiting, diarrhea, thrombosis
Use of Ergonovine for PPH?
2nd line - give alongside tranexamic acid) (used for asthmatic clients
Indication of use carboprost PPH?
2nd line - give alongside tranexamic acid; not used for active management) (used if client has cardia abnormalities)
