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Flashcards in Postpartum Hemorrhage Deck (14)
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Patient with postpartum hemorrhage – next step?

1. IV oxytocin
2. If ineffective, IM prostaglandin F2-Alpha OR rectal misoprostol


Definition of postpartum hemorrhage?

Greater than 500 mL blood loss and vaginal delivery or greater than 1000 mL during C-section


Uterine atony?

Lack of myometrial contractions


Methylergonovine maleate (Methergine)? Treatment for? Countraindicated if?

Ergot alkaloid agent that induces myometrial contractions

Uterine atony



Prostaglandin F2-Alpha – causes? Contraindicated in? (Why?)

Smooth muscle contraction; asthmatic patients (Bronchial constriction)


Most common cause of early postpartum hemorrhage? Most common cause if contracted uterus? Other causes?

Uterine atony

Genital tract lacerations (firm, contracted uterus)

1. Uterine invasion
2. Placenta creta or retained placenta
3. Coagulopathy


Risk factors for uterine atony?

1. Magnesium
2. Oxytocin
3. Rapid labor/delivery
4. Over distention of the uterus (macrosomia, multifetal pregnancy, hydramnios)
5. Chorioamnionitis
6. Prolonged labor
7. High parity


Early versus late postpartum hemorrhage?

Within 24 hours postpartum versus after 24 hours


Best initial management for uterine atony?

1. Uterine massage
2. Bimanual compression
3. IV oxytocin


If uterine massage with bimanual compression and oxytocin fails to reduce uterine atony, consider?

1. uterotonic agents (Methergine, prostaglandin F2-Alpha, misoprostol)
2. Surgery – exploratory laparotomy with interruption of blood vessels to the uterus (uterine artery/cardinal ligament ligation or internal iliac artery ligation)
3. Hysterectomy


Causes of late postpartum hemorrhage? (Time after delivery?)

1. Subinvolution of the placental site (10 to 14 days
2. Retained products of conception


Subinvolution of the placental site? Tx?

Eschar over the placental bed falls off, lack of myometrial contraction leads to bleeding

Ergot alkaloids


Signs of retained products of conception? Tx?

1. Uterine cramping and bleeding
2. Fever
3. Foul-smelling Lochia

Antibiotics and curettage


In patients with postpartum hemorrhage – can ligate what arteries? (effects on childbearing)

1. Internal iliac (hypogastric) – no hysterectomy
2. Cardinal ligaments (Tutoring artery) – hysterectomy necessary