Definitions/Numbers
What is the definition of postpartum hemorrhage?
Blood loss greater than or equal to 1000 ml or blood loss accompanied by signs and symptoms of hypovolemia within 24 hours of birth process.
What is proper management of uterine inversion?
Manual replacement of uterus +/- uterine relaxation (nitro, terbutaline, mag sulfate)
What are some etiologies of secondary PPH?
subinvolution of placenta site, retained POC, infection, coagulation defects
Uterine Atony accounts for 30-40% of PPH
False, 70-80%
May has two birthstones. Name one.
Emerald and agate
What decrease in hematocrit was historically a marker of postpartum hemorrhage?
10%
What are two surgical approaches to PPH?
Vascular ligation (Oleary sutures)
Uterine compression suture (B lynch) (1 chromic, rapidly absorbable - Why?)
Hysterectomy
Name 2 conditions that can contribute to massive blood loss and often cause coagulopathy.
AFE (triad of hemodynamic and respiratory compromise and DIC)
Placental abruption
False, Poly and prolonged induction are. Chorio, prolonged pitocin, multiple gestations and fibroids are among other risks
What are the two zodiac signs for May?
Taurus and Gemini
What percent of total blood volume is typically lost before signs such as tachycardia or hypotension develop?
25% or 1500 ml
Name three components of active management of the third stage of labor
1.Oxytocin administration
2. Uterine massage
3. Umbilical cord traction
What is risk of accreta in patient with placenta previa and history of 1,2 and 3 CS
3, 11, 40%
False. Occurs between 24 hours and 12 weeks postpartum
What is the name of the first permanent English settlement in America that was established on May 24, 1607?
Jamestown
What is massive transfusion protocol?
usually defined at 10 or more units PRBCs within 24 hours, transfusion of 4 U within one hour, or replacement of entire blood volume. Varies depending on institutions: pRBCS: FFP: PLT > 1:1:1
What are the four uterotonic agents?
bonus for dosing and contraindications
Oxytocin (IM 10 U, or infusion 10-40 U in 500-1000 ml)
Methylergonovine (0.2 mg IM, q 2-4 houra)
15 methyl PGF2alpha (0.25 mg IM, q 15-90 mins (max x 8))
Misoprostol (1000 mcg rectal)
What are the 4 Ts?
Tone (Uterine Atony)
Trauma (lacerations, hematomas, uterine rupture)
Tissue (retained placenta)
Thrombin (Pt's coagulation status)
The WOMAN trial showed that 1 g TXA given in PPH reduced number of blood transfusions required as well as reduced hospital LOS compared to placebo.
False.
Showed decreased mortality from obstetric hemorrhage when given within 3 hours of birth
Megan Eckert set the new women's six day running record in the month of May by running how many miles in 6 days?
603!
What are the lyrics leading up to the namesake of this category?
Every little thing I do, never seems enough for you, you dont want to lose it again. But I'm not like them. Baby, when you finally, set to love somebody, GUESS WHAT