Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Fetus > Obstetric haemorrhage > Flashcards

Obstetric haemorrhage Flashcards

1
Q

Why is obstetric haemorrhage important

A

Major cause of death in developing countries

Cause of up to 50% maternal deaths globally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 3 classes of obstetric haemorrhage

A

Antepartum
Primary postpartum
Secondary postpartum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is antepartum haemorrhage

A

Bleeding from genital tract from 24 weeks pregnancy, prior to birth
Usually caused by placenta praevia or abruption
Significant cause of maternal +fetal morbidity + mortality
Minor <50ml
Major 50-1000ml
Massive >1000ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is primary postpartum haemorrhage

A

Loss of 500ml or more blood from genital tract within 24 hours of birth
Major >1000ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is secondary postpartum haemorrhage

A

Abnormal/excessive bleeding from birth canal 24h-12 weeks postnatally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the blood volume changes in pregnancy

A

70ml/kg to 100ml/kg
Plasma vol increases 40-50%
Red cell mass increases 20-30%, relative anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why is increased blood volume in pregnancy beneficial

A

Facilitates maternal and fetal exchanges of respiratory gases, nutrients + metabolites
Reduces impact of maternal blood loss at delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the changes in clotting during pregnancy

A 
Relatively hypercoagulable
Decrease in fibrinolytic activity
Prevent excessive bleeding at delivery
Fibrinogen increased
Clotting factors increased (2, 7, 8, 10, 11, 12)
Platelet numbers increased
DDimer levels elevated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the compensatory changes during pregnancy

A

Heart rate increases, beats more forcefully
Blood vessels constricted, increased vascular resistance
Less urine secreted so lose less fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the causes of obstetric haemorrhage

A

Tone
Tissue
Trauma
Thrombin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe tone in obstetric haemorrhage

A

Abnormalities of uterine contraction

Risk factors for atonic bleeding = prolonged labour, overdistended uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe tissue in obstetric haemorrhage

A

Retained products of conception
Retained placenta
Placenta praevia
Morbidly adherent placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe trauma in obstetric haemorrhage

A

Uterine trauma- inverted uterus, ruptured uterus, scars, surgical damage
Genital tract trauma- vaginal tears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe thrombin in obstetric haemorrhage

A

Abnormalites of coagulation
Acquired coagulopathy in pregnancy- Sepsis, preeclamspia, placental abruption, retained dead fetus
Platelet abnormalities- gestationsal thrombocytopenia, HELLP syndrome, idiopathic/immunological thromboctopenic purpura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the minimal staff that should be present in theatre for obstetric haemorrhage

A

Midwife, labour ward coordinator, neonatal team, 2 obstetric surgeons, 2 anaesthatists, 2 theatre nurses, 2 anaesthetic nurses, support worker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What equipment is used in obstetric haemorrhage

A

Rapid infuser
Red cell salvage
Point of care testing

17
Q

What is a rapid infuser

A

Rapidly infuses + warms crystalloid, colloid blood

Ability to keep up with rapid blood loss

18
Q

What is red cell salvage

A

Collects + processes maternal blood from surgica site

Centrifuges, washes + returns red cells to patient

19
Q

What is point of care testing

A

ROTEM thromboelastometry tests whole blood clotting

Blood gas analyser guides resuscitation + blod

20
Q

What are the main uterotonic agents

A

Syntocinon
Ergometrin
Carboprost
Misoprostol

21
Q

What pharmacological treatments are there for obstetric haemorrhage

A

Uterotonic agents
Uterine atony treatment
Tranexamic acid for reduction of fibrinolysis

22
Q

What are surgical treatments for obstetric haemorrhage

A

Tone- uterine massage, B lynch suture, bakri baloon insertion
Tissue- removal of retained products, manual removal of placenta
Trauma- surgical repair

23
Q

What are the haematological treatments for obstetric haemorrhage

A

Replace circulating volume
Replace blood- cell salvage/allogenic
Correct coagulation with blood products

24
Q

How are blood products produced

A

Donated blood centrifuged, supernatant removed, frozen within 8 hours- fresh frozen plasma
FFP contains all clotting factors
Cryoprecipitate prepared from FFP- higher concentrations of clotting factors

25
Q

How are platelets produced

A

Centrifuging blood more slowly, pooling together from multiple donors
Given 1 bag at a time

26
Q

How is fibrinogen produced

A

Cryoprecipitate contains 100iu factor 8, 250mg fibrinogen
Also von willebrands factor, factor 13
Given as pooled units

27
Q

What is the major haemorrhage protocol

A

Aide memoire, reduce omission + human errors

Guide blood product replacement, aims for therapy

28
Q

What are the aims for haematological parameters

A 
Gm >8g/dl, normal 10-15
Haematocrit >0.3, normal 0.28-4
Prothrombin time <1.5 normal (12-13s)
Platelets >75x10^9, normal 150-400
Fribrinogen >2g, normal 3.7-6.2
29
Q

What bedside tests can be done

A

Serial blood gases, Hb/hct, lactate/ph/hco3

ROTEM (clotting)

Fetus (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions