Numbers
What percent of maternal deaths per year caused by PPH?
10%
First line for uterine atony
Uterine massage
The standard uterotonic given immediately after delivery. Its dosing and most effective route of administration.
What is oxytocin (pitocin)? 20 to 40 units / 500cc or 1 L NS or LR. Can also be given as 10 units IM, but this is less effective than IV.
Describe the 4 T's
Tone, trauma, tissue, thrombin
80% of PPH caused by this.
1 unit of packed RBC will usually increase Hgb by how much?
1 g/dL?
Describe O'Leary sutures
What is bilateral uterine artery ligation
Given as 800-1000 mcg rectally. Side effects?
What is misoprostol? Nausea, vomiting, diarrhea, fever.
What is a hemorrhage in a vaginal delivery? What about a c section?
Both 1000cc
Caused by uterine atony, retained placenta (especially accreta), coagulation defects, and uterine inversion
What is primary hemorrhage (within 24 hours)?
What change in Hematocrit constitutes PPH?
What is 10%?
What is filled with 300-500 cc of saline? How long can it remain in place?
What is Bakri balloon and 24 hours
What is dosage of PPH medication with HTN as contraindication?
What is 0.2 mg IM for methergine (methylergonovine)? May be given Q2-4 hours.
What hemoglobin is recommended a blood transfusion?
7 or 7.5 if symptomatic
Caused by subinvolution of placental site, retained POC, infection, or inherited coagulation defects.
What is secondary hemorrhage (24 hours-6 to 12 weeks)?
The blood component that increases 40% in pregnancy.
What is plasma volume?
The technique used to decrease blood flow to the uterus that is typically reserved for the stable PPH patient who is still bleeding despite other conservative measures.
What is uterine artery embolization?
The uterotonic that can be administered as frequently as every 15 minutes. Contraindications of this medication.
What is hemabate/ carboprost? Contraindicated in severe cardiovascular, renal and hepatic disease. Caution when used in asthmatics.
Pituitary necrosis that can occur from PPH?
Sheehan Syndrome
Cause of PPH that may be treated with manual extraction or curettage. What is a possible long term side effect of this procedure?
What is retained placental tissue? What is Asherman's syndrome?
At what blood loss percentage will signs of hemorrhage begin to be apparent?
15-25%
When bleeding continues cryoprecipitate is often used and contains these factors.
What is fibrinogen, von Willebrand Factor, factors 8 & 13, fibronectin?
What is TXA? Anti-fibrinolytic agent.
Extravasation of blood into the myometrium? What often causes this?
Consider in cases of HELLP, abruption, prolonged IUFD, sepsis, or amniotic fluid embolism.
What is coagulopathy?