Chapter 12: Post-partum Hemorrhage

Question 1

Sequelae of post-partum hemorrhage

Answer 1

Sequelae include adult respiratory distress syndrome, coagulopathy, shock, loss of fertility, and pituitary necrosis

Question 2

Primary vs. secondary PPH

Answer 2

Primary PPH occurs in the first 24 hours

Secondary occurs 24 hours to 12 weeks after delivery and is generally much less serious in nature

Question 3

What symptoms do we see based on blood loss

Answer 3

o 10-15% of blood loss can occur without any corresponding symptoms

o As blood loss approaches 20%: tachycardia, tachypnea, delayed cap refill, orthostatic changes, narrowed pulse pressure.

o Above 40-50% shock and death occur

Question 4

What causes most events of PPH?

Answer 4

o Most cases of PPH are caused by uterine atony: palpation of a “boggy” uterus in the abdomen.

o Supportive measures (IV access, type and cross, crystalloid infusion, coags) should be performed while the cause of the bleeding is being determined

Question 5

Predisposing conditions for PPH

Answer 5

Predisposing conditions include: excessive enlargement of the uterus, abnormal labor, and conditions that interfere with contraction of the uterus

Question 6

Management of uterine atony

Answer 6

Uterotonic agents are only effective for atony: Oxytocin, Methylergonovine maleate, misoprostol, dinoprostone, or 15-methyl prostaglandin F2a.

Surgical management: Uterine compression sutures, sequential arterial ligation, selective arterial embolization, and hysterectomy.

Question 7

Treatment of periurethral lacerations

Answer 7

Periurethral lacerations may cause edema occluding the urethra which can be fixed by a 12 or 24 hour foley catheter