Post-partum Hemorrhage Flashcards
What is the first thing to try with PPH?
Uterine massage
What medications should be given for PPH?
Oxytocin: 20–40 units in 500cc NS titrated to response (run fast)
Oxytocin 10 units IM
Misoprostol: 600–1,000 ug PR/PO or 600–800 SL
TXA 1g over 10 minutes
Methergine 0.2mg IM
Besides uterine compression and meds, what else should be initiated immediately with PPH?
Blood transfusion
If uterine massage, medications are not working, what are the next steps for PPH?
Intrauterine tamponade, call IR
Always be sure OB is on the way
How do postpartum patients respond to blood loss compared to normal people?
May not show signs of blood loss (tachycardia, hypotension) until later, meaning if these are present you should be worried
What risk factors for PPH?
Prolonged labor leading to uterine fatigue and atony
Retained placenta
What should be done after every delivery in regard to PPH?
Assess for uterine tone and examine the placenta
If severe PPH and the uterus is firm, then what?
Look for significant lacerations and clamp
What is the first question to answer when PPH is discovered?
Is the uterus firm?
What are the contraindications to methergine?
It causes HTN
Contraindicated if pre-eclampsia, HTN, or ischemic heart disease
What other medication can be given apart from oxytocin, misoprostol, and methergine? Dose and route? Contraindications?
Carboprost (Hemabate)
250mcg IM q15min
Can cause bronchospasm and is contraindicated in asthma
What can be done to correct coagulopathy in PPH?
Remember to check labs
If INR>1.5, give 4U FFP
If platelets <50,000 give 6 units platelets
If fibrinogen is <125 give 10U cryoprecipitate
Keep patient warm
What are the last ad definitive treatments for PPH?
OR with OB
Uterine artery ligation by IR
What needs to be done with the bladder in PPH?
Remember to insert foley and drain the bladder
