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ob/gyn🤰👩🏼‍🍼 > PPH > Flashcards

PPH Flashcards

1
Q

Main cause for maternal morbidity and mortality in the developing country is ?

A

Postpartum hemorrhage

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2
Q

What are the signs of placental separation ?

A

Uterus become firm
Gush of blood
Elongation of the cord

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3
Q

Postpartum hemorrhage has 4 definitions according to the gush of blood ?

A

More than 500-normal vaginal
More than 1000- elective cs
More than 1500-elective hysterectomy
More than 3000to 3500 in regent hysterectomy
10% drop in hematocrit between admission and postpartum or need blood transfusion

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4
Q

postpartum hemorrahage is classified to two types according to time of hemorrhage?

A

Primary -within 24 hours
Secondary 24 hours to 12 weeks

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5
Q

Uterine causes for postpartum hemorrhage?

A

1-Antony -most common
2-Abnormal placental separation
3-uterine rapture
4-uterine inversion

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6
Q

What are the types of abnormal placental separation ?

A

Abnormal placental ion (accreta)
Retained placental products

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7
Q

Non uterine causes for postpartum hemorrhage ?

A

-Laceration in the lower genitalia tract
-Coagulation disorder
-pelvic hematoma

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8
Q

Antepartum risk factors that lead to postpartum hemorrhage?

A

-Bleeding disorder
-Previous pph
-Manual removal of placenta
-Gestational hypertension
-over distended uterus

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9
Q

Intrapartum risk factors for having postpartum hemorrhage ?

A

-prolonged or rapid labor
-operative delivery
-Induction of labor
-coagulopathy
-shoulder dystocia
-chorioamnionitis

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10
Q

4 t of pph ?

A

Tone
Tissue
Trauma
Thrombin

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11
Q

Risk factor for a tonic pph ?

A

Prolong labor (lactic acid accumulation )
Full bladder
Rapid labor (less than 3 hours)
Multiparty
Pyre is during labor
Obesity
Antepartum risk factor

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12
Q

Blood flow t the uterus at term is —————every minute ?

A

1000ml per minute

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13
Q

Fetus at term receive about ———ml from placenta ?

A

200 ml

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14
Q

Postpartum hemorrhage prevention methods?

A

-Assets the risk factors
-do the third stage active management

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15
Q

What is the active management on third stage ?

A

-Controlled chord traction with suprapubic pressure
-prophylactic oxytocin

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16
Q

The dose for prophylactic oxytocin to prevent pph ?

A

-10 u IM
-5 u IV

17
Q

How we could predict he postpartum hemorrhage?

A

-when the PR/SBP is more than 1
That’s called the obstetric shock index

18
Q

If the obstetric shock index is more than one that indicate ? ,

A

High risk for postpartum hemorrhage with the need of blood transfusion

19
Q

Diagnostic steps for pph ?

A

1-check vital signs
2- fundus palpitations
3-uterine exploration
4-check lower genitalia
5-check the placenta

20
Q

Management for the pph ? (HAEMO_STAIS)

A

-Ask for help and hands on uterus to do massage
-assets abc and do the resuscitation
-establish the etiology and ensure the availability of blood
-massage the uterus
-oxytocin infusion and prostaglandins
-shift to the theater with compression (Manuel or aortic compression )
-tamponade by a balloon (Bakri balloon) after extraction of retained uterus
-apply compression suture on the uterus
Systemic pelvic devascularization
-intervention radiology for uterine artery emobalization
-sub total or total hysterectomy

21
Q

The tamponade has 2 ways in the pph ?

A

Bakri balloon
Packing

22
Q

The compression during pph has 2 ways ?

A

Manual compression
Normal saline compression

23
Q

First line drugs for primary postpartum hemorrhage

A

Oxytocin
Ergomrtrine

24
Q

Second line drug for pph ?

A

Misoprostol
Prostaglandins f2
Tranexmic acid

25
Q

What is the mode of action for Misoprostol?

A

Stimulate myometrial contraction

26
Q

Side effect of Misoprostol?

A

Diarrhea
Rash
Vomiting

27
Q

Prostaglandins f2 side effect ?

A

Vomiting
Bronchospasm
Dyspnea

28
Q

Other drugs for postpartum hemorrhage??

A

Carbetocin (pabal)
Sntometrine

29
Q

Syntometrine usually be combined with?

A

5 units of oxytocin
0.5 mg of ergometrine
It’s given for al of the women after delivery of the shoulder of the baby

ob/gyn🤰👩🏼‍🍼 (9 decks)

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