Flashcards in Postpartum Hemorrhage Deck (14)
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
Lack of myometrial contractions
Methylergonovine maleate (Methergine)? Treatment for? Countraindicated if?
Ergot alkaloid agent that induces myometrial contractions
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?
Genital tract lacerations (firm, contracted uterus)
1. Uterine invasion
2. Placenta creta or retained placenta
Risk factors for uterine atony?
3. Rapid labor/delivery
4. Over distention of the uterus (macrosomia, multifetal pregnancy, hydramnios)
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)
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
Signs of retained products of conception? Tx?
1. Uterine cramping and bleeding
3. Foul-smelling Lochia
Antibiotics and curettage