Am I Bleeding?
Name the precisely measured blood loss as compared to estimated blood loss.
What is quantified blood loss (QBL) versus estimated blood loss (EBL)?
Position the patient supine or in low Fowler's with head on pillow, arms relaxed and knees flexed for this assessment.
What is fundal assessment and if needed massage?
First line drug to maintain uterine tone after delivery.
What is oxytocin?
This postpartum problem can cause PPH.
What is bladder distension?
Your patient has no previous uterine incision, a singleton pregnancy, <or equal to 4 previous vaginal births, no bleeding disorder or history of PPH. Rate the PPH risk low, medium or high.
What is low risk?
Name the condition that is caused when there is a quantified blood loss (QBL) of 500mL or greater than 500mL for vaginal delivery and 1000mL or greater than 1000mL after a cesarean section.
What is postpartum hemorrhage?
You assess that your patient's fundal assessment is 2+ and deviated to the right of midline. You suspect this is caused by:
What is full bladder?
This medication should be questioned in a patient with a BP of 155/98.
What is methergine?
Blood-product that is administered to Rh-negative women who give birth to RH-positive newborns.
What is Rhogam?
Your patient is rated high risk for PPH because she has 4th degree laceration, and had a precipitous delivery. She has begun to bleed. While you start the fundal massage you request these two items be brought to the bedside.
What is bring the hemorrhage cart and uterotonic medications?
Name the emergency medical condition caused when there is large blood loss that results in severe compromised perfusion to body organs potential death.
What is hemorrhagic shock?
Have patient in lateral position with top leg bent at 90 degrees for this assessment.
What is assessment of episiotomy/laceration?
Expected outcome of administering prostaglandin F2 alpha/carboprost (Hemabate) IM.
What is control of postpartum hemorrhage by increasing uterine tone to limit blood loss?
Documentation of this will include color, amount, odor and clots.
What is lochia?
This must be assessed prenatally, on admission for delivery and through 24+ hours postpartum.
What is risk assessment for obstetrical hemorrhage?
Name the classification of drugs that stimulate contraction of smooth muscles.
What is uterotonic?
Called this when a patient's foot is flexed toward head and she reports pain in the calf.
What is a positive Holman's sign?
This medication can be given orally or rectally for PPH.
What is misoprostol (cytotec)?
Priority response to finding a perineal pad saturated within 15 minutes of placing the pad under the patient.
What is fundal massage?
Name three risk factors for postpartum hemorrhage.
What are prior CS, multiple gestation, more than 4 previous vaginal births, choriamnionitis, placenta previa, anemia, active bleeding, prolonged labor, oxytocin use, and MgSo4 use?
Name the life-threatening condition related to hemorrhaging that results in uncontrollable bleeding.
What is Disseminated Intravascular Coagulation (DIC)?
Abbreviation for redness, edema, ecchymosis, drainage and approximation.
What is REEDA?
This medication is used to treat PPH by inhibiting the breakdown of fibrin blood clots. It must be given within 3 hours of birth.
What is Tranexamic acid (TXA)?
One hand is placed just above the symphysis pubis and the other on the fundus and is used to expel clots and firm a boggy uterus.
What is uterine massage?
This mnemonic is used as a reminder of potential sources of PPH. And name them out.
What are the 4T's?
Tone atony is most common cause of PPH
Trauma laceration, hematoma, uterine inversion or rupture.
Tissue retained placenta.
Thrombin bleeding disorders such as DIC