Physiology
The blood loss percentage at which signs of hemorrhage become apparent (changes in vital signs).
What is up to 30%? (AWHONN)
-Usual signs of blood loss are altered by hemodynamic/hematologic changes in pregnancy.
-Often give providers a false sense of security.
The 4 causes of OB Hemorrhage (Begin with "T").
What are tone, trauma, tissue and thrombin?
PPH that occurs within the 1st 24 hours after birth and the most common cause of uterine atony.
What is primary or early PPH?
Given as 800-1000 mcg rectally or 600 mcg buccally
What is cytotec (misoprostol)?
The changes in pregnancy affecting the pregnant women vs. non-pregnant women.
Dilutional Anemia
Mild Thrombocytopenia
Decreased fibrinolysis
Typically employed after other conservative measures have failed, this PPH intervention works by applying temporary, uniform pressure to the lower uterine segment while allowing for continued monitoring of blood loss.
What is the uterine tamponade device (Bakri) balloon?
More accurate than EBL.
What is QBL?
Medication routinely given after birth
What is oxytocin (pitocin)? 30 units / 500cc NS or LR. Can also be given as 10 units IM.
One of your 1st interventions to prevent PPH
What is vigorous fundal massage/empty bladder/move along quickly with medications?
Blood component that increases 30-50% in pregnancy.
What is blood volume?
-RBC's increase 30%
-Plasma volume increases 50%
Dilutional anemia (HgB 10 can be normal)
The radiologically-guided technique used by IR to decrease blood flow to the uterus that is typically reserved for the stable PPH patient who is still bleeding after treatment with other conservative measures.
What is arterial embolization?
-Percutaneous transcatheterization occludes both uterine arteries with particulate emboli and reduces pelvic bleeding.
Most common cause is retained placental tissue
What is secondary or late PPH (between 24 hours-6 to 12 weeks)?
What is drug/dosage of PPH medication with HTN as contraindication?
What is 0.2 mg IM for methergine (methylergonovine)? May be given Q2-4 hours.
Cause that may be "hidden" but can lead to significant QBL with c/o pressure / pain. Single source not usually able to be identified.
What is genital tract hematoma? May be treated with I&D, drain placement, incisional suture, vaginal packing, or management by interventional radiology.
What constitutes hemorrhage in Cesarean delivery?
What is >1000 cc QBL?
The med that is not used as a 1st line medication but is very effective in the Tx of PPH
Tranexamic Acid (TXA) - 1000 mg given IVPB over 15-30 . May repeat in 30 minutes.
Type of shock after severe PPH
What is hypovolemic shock?
In this procedure, the interventional radiologist inserts balloon catheters into the internal iliac arteries feeding the uterus to decrease blood flow.
What is uterine balloon occlusion?
-This decreases uterine blood supply significantly which leads to reduced blood loss.
What constitutes PPH in a vaginal birth?
>500 cc (ACOG changed it to 1000 FYI)
In which patients should Hemabate not be given?
What is asthmatic patients? May be given as 0.25 mg IM q15-90 min. Also relative contraindications in hepatic, renal, and cardiac disease patients. Diarrhea, fever, tachycardia common.