Causes of PPH
The most common cause of PPH
Uterine atony
This common cause of uterine atony is caused by overdistention of the uterus. This is commonly seen with _________ (name three)
Multiple gestation, macrosomia, polyhydramnios
The definition of a PPH
Blood loss > 1,000 mL OR blood loss accompanied by sxs of hypovolemia
First line response to PPH includes these 4 interventions:
Uterine massage (bimanual), IV access, crystalloid fluids, oxytocin
This is our go to med
Pitocin (20 units IM), can also be 20-40 units IV in 500-1,000 mL or LR
This cause of PPH is usually diagnosed 30-60 minutes after the birth of the baby
Retained placenta
This common cause of uterine atony can be easily solved with a straight catheter
full bladder
If a person is having an INTRAPARTUM hemorrhage OOH and birth is not imminent, what should happen:
Transfer to the hospital
Perform __________ to help deliver the __________; if this doesn't work _____________.
gentle cord traction / placenta; manually remove the placenta
This medicine has a rapid onset and can be administered without an IV
IM methergine (0.2 mg), takes 2-5 minutes to start working, avoid with HTN
We should be suspicious of this cause if someone presents to care with a hx of HMB since menarche
Inherited coagulopathy (bleeding disorder)
A very _____ labor, or a very _____ labor, can cause uterine atony.
Precipitous labor/ prolonged labor (also prolonged 2nd stage!)
pharmacologic prophylaxis, gentle cord traction, early skin-to-skin contact
If the placenta is already delivered, and the person is still bleeding, perform ____________.
bimanual compression
This medicine takes 20-30 minutes to start working, also can be used without an IV
Cytotec, 1,000 mcg PR
This common cause of PPH has nothing to do with the uterus
Vaginal laceration/ tissue trauma
Many of BSD's older clients are at increased risk for PPH due to this status: ______________
Grand multip, or great-grand multipara status
We do not do this at the birth center unless there is an emergency, i.e. bleeding
Manual removal of the placenta
Check for ____________ to assess for other causes of bleeding.
tissue trauma (start suturing!)
This is the only treatment proven to reduce the rate of death from PPH in a randomized trial
TXA, 1g of TXA (given intravenously in 100 mL of NaCl over 10 minutes), repeat w/ a 2nd dose if still bleeding after 30 minutes or bleeding starts again at any point in the first 24h after birth, must be administered within 3h of birth
The majority of people who have a PPH have none of these: _________
Identifiable risk factors
Other causes of uterine atony include (name at least three):
Infection, distortions of the uterine cavity (fibroids), placental abnormalities (accreta, percreta), uterine rupture
After a PPH always do this!
Debrief with the client
Other best practices to do during a PPH (name 5)
straight cath the bladder, place an 18 gauge IV and give LR fluid bolus, start a QBL, monitor maternal vitals signs, give rectal or buccal miso, IM methergine, TXA, use a Jada
Consider sending a client home on a ____________ for 1-3 days if a client has a PPH.
PO methergine series (0.2 mg PO methergine q 6h for 24-72 hours)