pp hemorrhage Flashcards
hemorrhage is defined as
blood loss >500ml
maternal hemorrhage accounts for __% of maternal deaths perinatally
25
one can bleed to death in __ minutes
7
early pp hemorrhage is considered
in the 1st 24 hours
late pp hemorrhage is
1 day to 6 weeks
late pp hemorrhage is usually dt
retained fragments and pp infxn
late pp hemorrhage is more likely to be complicated by
DIC
RF for hemorrhage
partial separation long labors twins polyhydramnios precipitous labor-shock to baby full bladder- decreases effort to uterine contractions mismanagement of 3rd stage- fundal fiddling abnormal placental placement psychological decreased Hgb fibroids chorioamnionitis grand multip lacerations anesthesia/epidural- decrease muscular response forceps- uterine trauma of lower segment light skin/red hair previous hemorrhage
characteristics of hemorrhage
gushes
slow trickle
firm uterus but bleeding
non-visible hemorrhage-rising fundus, clots or gush comes out with pressure
bright red blood-artery ruptured
pelvic pain with decreased BP with or without bleeding
what is the first line of treatment
assist delivery of placenta
most hemorrhages will abate with delivery of placenta
treatment options
tell mom to stop bleeding- engage her check placenta for completeness--->manual sweep or D&C nipple stim herbs massage pitocin methergine shock position IV push oxygen threaten hospital transport catheterize cytotec or hemabate
uterin massage
help the upper segment to contract: Put 1 hand on top of fundus and press caudally to stimulate uterus to contract
bimanual compression
use 2 hands and with the uterus between the hands use an inner motion to stimulate uterus to contract
internal bimanual compression
put 1 hand inside uterus with sterile glove and the other on top of the fundus squeezing the fundus between your 2 hands
pitocin
causes irregular contractions, Onset: 3-5 minutes, lasts 1 hour;
Sig: 10 -20 units (1-2cc) IM usually vastus lateralis 10-40 units in 1000 cc IV fluid (D5W)
methergine
causes one tetanic contraction Onset: 2-5 minutes, lasts 2-4 hours; Sig: 0.2 mg IM. * CI in hypertensive pts
cytotec
misoprostil; Inexpensive, stable at room temp Dose: 4-10 100 mcg tablets bucally or rectally Onset: 5-15 minutes
hemabate
carboprost tromethamine; expensive, must be refrigerated Dose: 250mcg deep IM injection; Onset: 15 minutes; Side Effects: Vomiting, diarrhea in 2/3 pts
hypovolemic shock
Decreased blood volume dt internal or external hemorrhage
Main type in deliveries; dehydration-sweating, diarrhea, vomiting
cardiogenic shock
heart failure
neurogenic/vasogenic shock
Decreased vascular tone leads to anaphylactic shock which is an over-release of histamine which leads to vasorelaxation of PNS. Maybe dt sepsis, blood poisoning, bee sting, etc.
psychogenic shock
Fainting dt vasorelaxation then vasoconstriction
ssx shock
Restlessness Anxiety Spaciness Foreboding feeling Denial of problem Rapid, shallow respiratory rate Inc HR but weak and thready Inc BP is early sx Dec BP is late sx BP-systolic < 80 or a change of 10 mm Hg from normal Decrease pulse-pressure (distance between systolic/diastolic) Skin clammy, cool, pale, except in neurogenic shock the skin is warm and flushed N+V, pupils dilated
mild shock
Loss of 15-30% of blood volume (3-4 cups)
A non-pregnant woman has 12 cups of blood in body, 15-18 in pregnant state
Decrease of 10 points or more in Systolic BP
Increase of 10 points or more in HR (pulse)
Mild tachypnea, rapid, shallow respiration
