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Risk Factors & Prevention
Non-medication mgmnt
Definitions
Causes of PPH
100

Risk factors involving the placenta that can increase risk for postpartum hemorrhage

What are abnormal placentation issues including previa, accreta, increta, percreta, or concern on admission for placental etiology such as an abruption

100

This technique is used to bilaterally ligate the uterine arteries, thus occluding 90% of the blood flow to the uterus.

What is the O'Leary stitch?

100
Caused by uterine atony, retained placenta (especially accreta), coagulation defects, and uterine inversion.
What is primary hemorrhage (within 24 hours)?
100
The cause of 80% of cases of PPH.
What is uterine atony?
200

Important patient history risk factors for postpartum hemorrhage involving the uterus or current pregnancy.

What is uterine surgery (h/o CS, D&C), fibroids, known coagulation defect, multiple gestations, polyhydramnios, h/o PPH, >4 prior deliveries

200
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 Bakri balloon?
200

The EBL that constitutes hemorrhage in vaginal delivery.

What is >1000 cc EBL?

200
Cause of PPH that may be treated with manual extraction or curettage.
What is retained placental tissue?
300

Three ways to actively manage the third stage of labor to prevent the risk of PPH

What are administering oxytocin, uterine massage, and umbilical cord traction/ delivery of placenta

300
The radiologically-guided technique used 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 uterine artery embolization?
300

Caused by subinvolution of placental site, retained POC, infection, or inherited coagulation defects.

What is secondary postpartum hemorrhage (24 hours-6 to 12 weeks)?

300

Cause that may be "hidden" but can lead to significant EBL with c/o pressure/pain, treatment options for this condition, and the most common challenge associated with invasive treatment.

What is genital tract hematoma? May be treated with I&D, drain placement, incisional suture, vaginal packing, or management by interventional radiology. Single source of bleeding often not recognized.

400

When you should start actively preventing a postpartum hemorrhage.

Immediately upon delivery! All the time!

400
During a laparotomy for PPH, this technique is used to apply uniform uterine compression using absorbable sutures that encircle the body of the uterus.
What is the B-Lynch suture?
400
The EBL that constitutes hemorrhage in Cesarean delivery.
What is >1000 cc EBL?
400
Cause of PPH that may be ruled out by careful assessment of lower genital tract.
What are lacerations?
500

The 4 T's of postpartum hemorrhage.

What are tone, trauma, tissue, and thrombin.

500
A technique that can be performed either unilaterally or bilaterally at the time of ex-lap for PPH that is used to further decrease pulse pressure to the uterus after other conservative measures have failed.
What is hypogastric artery ligation?
500
The percentage change in Hematocrit that constitutes a PPH.
What is 10%?
500
Cause of PPH that should be considered in cases of HELLP, abruption, prolonged IUFD, sepsis, or amniotic fluid embolism.
What is coagulopathy?