Chapter 33 Flashcards
(38 cards)
This term is defined as - excessive bleeding after childbirth defined as a blood loss of _____ ml or more after a vaginal birth and ____ ml after a cesarean birth
Also defined as a 10% drop in ______
Postpartum Hemorrhage 500 1000 Hct Tip - : lochia accounts for 25% of total blood loss. Largest loss occurs during delivery and immediately after.
How do we remove retained placental fragments?
What is the test that confirms presence of retained products of conception?
Manual exploration done to remove fragments
Ultrasonography confirms retained products of conception
Will separation occur if there is abnormal adherence of placenta?
No, separation will not occur in these instances
What is the cause of abnormal adherence of placenta related to?
Related to implantation of zygote in area of defective endometrium
What are the types of placental attachments?
Placenta acreta – slight penetration of myometrium
Placenta increta – deep penetration of myometrium
Placenta percreta – perforation of uterus
Placenta Acreta is…
A Type of placental attachment -> Slight penetration of myometrium
Placenta Increta is…
A type of placental attachment -> Deep penetration of myometrium
Placenta Percreta is…
A type of placental attachment -> Perforation of Uterus
If your assessment revealed that the uterus is firm and well contracted but constant trickle is present or frank bleeding - What may be the cause? How To Manage?
Genital tract lacerations
Usually cervix, vagina, perineum (most common)
Sutures
Definition: Collection of blood in connective tissue of pelvis, vagina, vulva
Hematoma
Most common symptom of a hematoma?
Pain
Patient presents with hemorrhage, shock, pain, non-palpable uterus on assessment - What may be the cause
(Hint)
The Uterus is turned inside out
Uterine Inversion
Management of uterine inversion
Replace uterus by obstetrician, must be relaxed, treat shock
Fundal implantation of placenta (abnormal), vigorous fundal pressure, excessive traction to cord, short cord, and uterine relaxant (Mg SO4) are all causes of what disorder?
Uterine Inversion
Is Uterine Inversion considered an Emergency?
YES
Definition: Delayed return of enlarged uterus to normal size and function
Subinvolution of the uterus
Common causes of subinvolution of the uterus
retained placental fragments and infection
S/S of this disorder include prolonged lochial discharge, excessive bleeding, and pain
Subinvolution of the uterus
Management of subinvolution of the uterus?
- Treatment is based on cause. D&C may be needed,
- Methergine 0.2 mg q 3-4 hr x 24 hrs contraindication is HTN
- ABX therapy
Management of PPH?
- Identify cause of PPH
- Assess uterine fundus – palpate (first action)
if boggy, perform fundal massage
if firm but blood trickle present, inspect m
perineum, vagina uterus, cervix - Assess bladder
if distended straight catheterization may be
indicated - Continue infusion of oxytocin (20 units/1L RL, 30
units/500 ml LR) - Laboratory studies: hemoglobin & hematocrit (h/h)
- Adhere to PPH protocol of unit
If atony of uterus persists - even after a firm massage of fundus, emptied bladder, and continued IV oxytocin - then what do you do?
Administer other uterotonic medication:
Besides oxytocin, name other uterotonic meds
Misoprostol (Cytotec) a synthetic prostaglandin E1 given rectally, sublingually, or orally
Methylergonovine (Methergine) given IM or po to produce sustained uterine ctx
Hemabate IM
Prostaglandin E2 (Dinoprostone) given vaginally or rectally
Blood or blood products, LR or NS
Oxygen therapy and foley catheter placed if needed
If bleeding persists, bimanual compression is performed
Surgical management optons for hematoma and bleeding
- Hematoma - Incision and drainage
- Uterine Tamponade - uterine packing with thrombin or insertion of intrauterine balloon
- Bilateral Uterine Artery Ligation
- Ligation of utero-ovarian arteries and infundibulopelvic vessels
- Total Abdominal Hysterectomy (TAH)
Give the common weights in grams (ie if a person soaked a chux pad, estimate how much blood loss there would be) Chux Peri-pad Vaginal pack Bath towel Hospital gown Flat sheet
40 gm - Chux 15 gm - Peri pad 20 gm - Vaginal pack 200 gm - Bath Towel 370 gm - Hospital Gown 75 gm - Flat Sheet
