16 - Obs - The Puerperium - PPH Flashcards by Vish Gossain

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Flashcards in 16 - Obs - The Puerperium - PPH Deck (11):

1’ PPH = loss of >? blood 1000ml after ? ?). ?% women. Major cause of maternal ?

500ml
24h
CS
10%
mort

Aetiology
4 T's?

Trauma
Tone
Thrombin
Tissue

Aetiology
3 common causes
3 rare causes

common - retained placental fragments, atonic uterus, perineal trauma

rarer - uterine rupture, cervical tear, high vaginal tear

Aetiology
Uterine: ?%. Uterus fails to ?
properly, as it’s ? or ?
placenta/part of placenta. Atony more common w ?
labour, grand ? and ? of uterus (? and ? preg) and fibroids.

80%
contract
atonic
retained
prolonged
multiparity
overdistension
polyhydramnios
multiple

Aetiology

Retained Placenta: 2.5% delivs. ? separation -> blood accum in ?, which rises. ? may occur in absence of ? loss.

Coagulopathy: Rare. ?
disorders, ? therapy or ??? all cause PPH.

partial
uterus
collapse
external

congen
anticoag
DIC

Aetiology

Vaginal: ?%. Bleeding from ?
tear or ? obvious, ? ? tear considered, esp if ? deliv.

Cervical Tears: Rare, but ass w precipitate labour and ?
deliv.

20%
perineal
episiotomy
high vaginal
instrumental

instrumental

Prevention

Routine use of ? in ? stage reduces incidence by ?%. As effective as ergometrine, which often causes ?, and is contraindicated in ? women.

oxytocin
3rd
60
vomiting
HTN

Clinical Features

Blood loss should be ? after deliv of ?. Enlarged uterus above ? suggests ? cause. Vaginal ? and ? inspected for tears. Blood loss can be ?– collapse w/o pain if ?bleeding

minimal
placenta
umbilicus
uterine
walls
cervix
abdominal
overt

MGMT

Resuscitate: Pt lied ?, ??
access, ? match and blood ?
restored. ?, haematological and senior ? help.

Retained placenta: Removed ? if bleeding or not expelled as normal within ?mins.

flat
IV
cross
volume
anaesthetic
obstetric

manually
60mins

MGMT
To ID and Treat cause:
?? to exclude rare uterine ?
and uterus bimanually ?. Vaginal ? are palpable. ?cause common and ? given IV to contract uterus if no ?. If failure, examine inder ??(EUA).

VE
inversion
compressed
lacerations
uterine
oxytocin
trauma
GA

MGMT

EUA: cavity of ? explored for retained ?, then ? and ?
inspected for tears -> ?. If uterine ? persists, PGF2a injected into ?.

Persistent haemorrhage despite trt: needs ?. Bleeding from placental ? may respond to placement of a ? balloon. Other methods: ? suture and uterine ? ?. ? if failure.

uterus
placenta
cervix
vagina
sutured
atony
myometrium

surgery
bed
rusch
brace
aa embolization
hysterectomy

Decks in CP2 Class (339):

16 - Obs - The Puerperium - PPH Flashcards Preview

CP2 > 16 - Obs - The Puerperium - PPH > Flashcards

1’ PPH = loss of >? blood 1000ml after ? ?). ?% women. Major cause of maternal ?

500ml
24h
CS
10%
mort

Aetiology
4 T's?

Trauma
Tone
Thrombin
Tissue

Aetiology
3 common causes
3 rare causes

common - retained placental fragments, atonic uterus, perineal trauma

rarer - uterine rupture, cervical tear, high vaginal tear

Aetiology
Uterine: ?%. Uterus fails to ?
properly, as it’s ? or ?
placenta/part of placenta. Atony more common w ?
labour, grand ? and ? of uterus (? and ? preg) and fibroids.

80%
contract
atonic
retained
prolonged
multiparity
overdistension
polyhydramnios
multiple

Aetiology

Retained Placenta: 2.5% delivs. ? separation -> blood accum in ?, which rises. ? may occur in absence of ? loss.

Coagulopathy: Rare. ?
disorders, ? therapy or ??? all cause PPH.

partial
uterus
collapse
external

congen
anticoag
DIC

Aetiology

Vaginal: ?%. Bleeding from ?
tear or ? obvious, ? ? tear considered, esp if ? deliv.

Cervical Tears: Rare, but ass w precipitate labour and ?
deliv.

20%
perineal
episiotomy
high vaginal
instrumental

instrumental

Prevention

Routine use of ? in ? stage reduces incidence by ?%. As effective as ergometrine, which often causes ?, and is contraindicated in ? women.

oxytocin
3rd
60
vomiting
HTN

Clinical Features

Blood loss should be ? after deliv of ?. Enlarged uterus above ? suggests ? cause. Vaginal ? and ? inspected for tears. Blood loss can be ?– collapse w/o pain if ?bleeding

minimal
placenta
umbilicus
uterine
walls
cervix
abdominal
overt

MGMT

Resuscitate: Pt lied ?, ??
access, ? match and blood ?
restored. ?, haematological and senior ? help.

Retained placenta: Removed ? if bleeding or not expelled as normal within ?mins.

flat
IV
cross
volume
anaesthetic
obstetric

manually
60mins

MGMT
To ID and Treat cause:
?? to exclude rare uterine ?
and uterus bimanually ?. Vaginal ? are palpable. ?cause common and ? given IV to contract uterus if no ?. If failure, examine inder ??(EUA).

VE
inversion
compressed
lacerations
uterine
oxytocin
trauma
GA

MGMT

EUA: cavity of ? explored for retained ?, then ? and ?
inspected for tears -> ?. If uterine ? persists, PGF2a injected into ?.

Persistent haemorrhage despite trt: needs ?. Bleeding from placental ? may respond to placement of a ? balloon. Other methods: ? suture and uterine ? ?. ? if failure.

uterus
placenta
cervix
vagina
sutured
atony
myometrium

surgery
bed
rusch
brace
aa embolization
hysterectomy

Decks in CP2 Class (339):

Who Is It For?

16 - Obs - The Puerperium - PPH Flashcards Preview

CP2 > 16 - Obs - The Puerperium - PPH > Flashcards

1’ PPH = loss of >? blood 1000ml after ? ?). ?% women. Major cause of maternal ?

500ml24hCS10%mort

Aetiology4 T's?

TraumaToneThrombinTissue

Aetiology3 common causes3 rare causes

common - retained placental fragments, atonic uterus, perineal traumararer - uterine rupture, cervical tear, high vaginal tear

Aetiology Uterine: ?%. Uterus fails to ? properly, as it’s ? or ? placenta/part of placenta. Atony more common w ? labour, grand ? and ? of uterus (? and ? preg) and fibroids.

80%contractatonicretainedprolongedmultiparityoverdistensionpolyhydramniosmultiple

Aetiology Retained Placenta: 2.5% delivs. ? separation -> blood accum in ?, which rises. ? may occur in absence of ? loss.Coagulopathy: Rare. ? disorders, ? therapy or ??? all cause PPH.

partialuteruscollapseexternalcongenanticoagDIC

AetiologyVaginal: ?%. Bleeding from ? tear or ? obvious, ? ? tear considered, esp if ? deliv.Cervical Tears: Rare, but ass w precipitate labour and ? deliv.

20%perinealepisiotomyhigh vaginalinstrumentalinstrumental

PreventionRoutine use of ? in ? stage reduces incidence by ?%. As effective as ergometrine, which often causes ?, and is contraindicated in ? women.

oxytocin3rd60vomitingHTN

Clinical FeaturesBlood loss should be ? after deliv of ?. Enlarged uterus above ? suggests ? cause. Vaginal ? and ? inspected for tears. Blood loss can be ?– collapse w/o pain if ?bleeding

minimalplacentaumbilicusuterinewallscervixabdominalovert

MGMTResuscitate: Pt lied ?, ?? access, ? match and blood ? restored. ?, haematological and senior ? help.Retained placenta: Removed ? if bleeding or not expelled as normal within ?mins.

flatIVcrossvolumeanaestheticobstetricmanually60mins

MGMTTo ID and Treat cause: ?? to exclude rare uterine ? and uterus bimanually ?. Vaginal ? are palpable. ?cause common and ? given IV to contract uterus if no ?. If failure, examine inder ??(EUA).

VEinversioncompressedlacerationsuterineoxytocintraumaGA

MGMTEUA: cavity of ? explored for retained ?, then ? and ? inspected for tears -> ?. If uterine ? persists, PGF2a injected into ?.Persistent haemorrhage despite trt: needs ?. Bleeding from placental ? may respond to placement of a ? balloon. Other methods: ? suture and uterine ? ?. ? if failure.

uterusplacentacervixvaginasuturedatonymyometriumsurgerybedruschbraceaa embolizationhysterectomy

500ml
24h
CS
10%
mort

Aetiology
4 T's?

Trauma
Tone
Thrombin
Tissue

Aetiology
3 common causes
3 rare causes

common - retained placental fragments, atonic uterus, perineal trauma

rarer - uterine rupture, cervical tear, high vaginal tear

Aetiology
Uterine: ?%. Uterus fails to ?
properly, as it’s ? or ?
placenta/part of placenta. Atony more common w ?
labour, grand ? and ? of uterus (? and ? preg) and fibroids.

80%
contract
atonic
retained
prolonged
multiparity
overdistension
polyhydramnios
multiple

Aetiology

Retained Placenta: 2.5% delivs. ? separation -> blood accum in ?, which rises. ? may occur in absence of ? loss.

Coagulopathy: Rare. ?
disorders, ? therapy or ??? all cause PPH.

partial
uterus
collapse
external

congen
anticoag
DIC

Aetiology

Vaginal: ?%. Bleeding from ?
tear or ? obvious, ? ? tear considered, esp if ? deliv.

Cervical Tears: Rare, but ass w precipitate labour and ?
deliv.

20%
perineal
episiotomy
high vaginal
instrumental

instrumental

Prevention

Routine use of ? in ? stage reduces incidence by ?%. As effective as ergometrine, which often causes ?, and is contraindicated in ? women.

oxytocin
3rd
60
vomiting
HTN

Clinical Features

Blood loss should be ? after deliv of ?. Enlarged uterus above ? suggests ? cause. Vaginal ? and ? inspected for tears. Blood loss can be ?– collapse w/o pain if ?bleeding

minimal
placenta
umbilicus
uterine
walls
cervix
abdominal
overt

MGMT

Resuscitate: Pt lied ?, ??
access, ? match and blood ?
restored. ?, haematological and senior ? help.

Retained placenta: Removed ? if bleeding or not expelled as normal within ?mins.

flat
IV
cross
volume
anaesthetic
obstetric

manually
60mins

MGMT
To ID and Treat cause:
?? to exclude rare uterine ?
and uterus bimanually ?. Vaginal ? are palpable. ?cause common and ? given IV to contract uterus if no ?. If failure, examine inder ??(EUA).

VE
inversion
compressed
lacerations
uterine
oxytocin
trauma
GA

uterus
placenta
cervix
vagina
sutured
atony
myometrium

surgery
bed
rusch
brace
aa embolization
hysterectomy