Obstetric Hemorrhage, Sepsis - Moulton Flashcards
(26 cards)
How much blood (PRBCs) must I give to raise the Hgb by 1 and the Hct by 3?
1 unit (250-300 cc)
A pregnant patient is bleeding BEFORE birth. What must first be determined BEFORE using your fingers to examine?
Placenta previa (could rupture membranes with fingers)
Placental abruption, previa, uterine rupture – bleed when?
AFTER 20 weeks
Pain or no?
- Previa vs. Abruption
More common?
- Previa vs. Abruption
Previa - no
Abruption - yes
Abruption
Risk factors for placenta previa
- Over 35 years
- Multiparity
- Multiple gestations
- Prior previa
- Previous C-section
3 kinds of placenta previa
- Marginal (does NOT cover Os)
- Partial
- Complete
Most placenta previa’s diagnosed at 30 weeks will do what?
“Migrate” by 32-35 weeks
When/how are unresolved placenta previa’s delivered?
C-section – 36-37 weeks (BEFORE LABOR) WHEN fetal lungs are mature
Placenta percreta (through myometrium) – manage how?
C-section hysterectomy
Most common risk factor for placenta abruption
Maternal HTN
If external trauma to the pregnant abdomen occurs, when will abruption most likely occur?
Within 6 hours
***Sudden intense, painful bleeding after 20 weeks - most likely?
Will often see what on baby exam? Cervical exam if during labor?
Placenta abruption
Abnormal FHR
Regression of “station”
Abruption is the most common cause of ____ in pregnancy
DIC
- ***Chance of uterine rupture after…
- Low transverse uterine incision
- Classical/vertical incision (C-section, myomectomy)
1%
4-7%
Vasa previa
How to diagnose?
Unprotected fetal vessel passing over the cervical os
Acute vaginal bleeding, tachycardia followed by bradycardia
Postpartum hemorrhage/bleeding w/in first 24 hours…? (1)
24 hours to 12 weeks? (3)
Uterine atony (80%)
Sloughing of eschar, retained products, subinvolution of uterus
***Postpartum palpation reveals a “boggy uterus”, bleeding from vagina
Risk factors?
Uterine atony
- Overly large uterus (multiples, polyhydramnios)
- Abnormal labor
- Leiomyoma
- Mag. sulfate
***A patient has a complicated labor and is on oxytocin for a prolonged period of time. Risk? Why?
Postpartum uterine atony
Oversaturated receptors –> weak contraction later
Non-pharm management of uterine atony
Bimanual massage of uterus
2 drugs for uterine atony w/ contraindications
Other drugs?
Methylergonovine (Methergine) – HTN
15-methyl-PGF2a (Hemabate) – ASTHMA
Oxytocin, Dinoprostone, Misoprostol
Postpartum, develops respiratory distress, cyanosis, CV collapse, hemorrhage, coma
Treatment?
Prognosis?
Amniotic fluid embolism
Respiratory support, correct shock, replace clotting factors
BAD (80% death)
Puerperal sepsis - defined as what?
This is generally called what?
Fever over 100.4 AFTER the first 24 hours for 2+ days within the first 10 days
Endometritis
Puerperal sepsis - most common organisms
If aerobic?
Anaerobic cocci (Peptostrepto, Pepto, Strepto)
E. coli, Enterococci
Postpartum - fever, uterine tenderness on days 2-3 (+ chills, malaise, anorexia)…
Most likely Dx?
Treatment? Most common regimen?
If resistant to the above regimen, most likely bug? Treatment?
Puerperal sepsis (endometritis)
Antibiotics - Ampicillin + Gentamicin
B. fragilis – Clindamycin
