UW postpartum uterine atony 03-24 (2)

Question 1

UW table. postpartum uterine atony. Risk factors? 5

Answer 1

Uterine fatigue from prolonged, induced or precipitous labor
Intraamniotic infection
Uterine overdistension (multiple gestation, macrosomia, polyhydramnios)
Retained placenta
Grand multiparity (>=5 prior deliveries)

Question 2

UW table. postpartum uterine atony. CP? 2

Answer 2

MCC of postpartum hemorrhage
Enlarged, soft, boggy, poorly contracted uterus

Question 3

UW table. postpartum uterine atony. Intervetions list

Answer 3

Bimanual uterine massage
Correction of bladder distension
High dose oxytocin, misoprostol
Tranexamic acid
Carboprost, methylergonovine
Intrauterine ballon tamponade
Possible surgical intervention (is atony unresolved)

Question 4

UW. Some patients may not have an immediate PPH (eg 1 hour after delivery). why?

Answer 4

because blood can gradually accumulate in the lower uterine segment (the least contractile portion of the uterus).

Question 5

UW. When atony manifests + cause hemorrhage. time?

Answer 5

withint 24hours post delivery

Question 6

UW. Postpartum hemorrhage (PPH) is defined as an estimated blood loss ???? ml or Cp

Answer 6

≥1,000 mL OR bleeding with signs/symptoms of hypovolemia.

Question 7

UW. step-wise approach. Initial Mx?

Answer 7

placement of 2 large-bore intravenous lines for volume resuscitation.

Question 8

UW. step-wise approach. After initial, first step? 2

Answer 8

Bimanual uterine massage (and bladder catheterization) are performed to improve uterine tone.

Question 9

UW. step-wise approach. after massage next step? drug

Answer 9

High-dose oxytocin, the first-line uterotonic agent, is administered.

Question 10

UW. step-wise approach. persists after oxytocin?

Answer 10

best next step in management is tranexamic acid

Question 11

UW. step-wise approach. persists after tranexamic acid?

Answer 11

second-line uterotonic medications, including carboprost tromethamine, methylergonovine, and misoprostol.

Question 12

UW. step-wise approach.
in what patients contraindicated Carboprost tromethamine ?

Answer 12

in patients with asthma due to the risk of bronchospasm

Question 13

UW. step-wise approach. Methylergonovine is contraindicated in what patients?

Answer 13

hypertension (regardless of the patient’s current blood pressure) due to an increased risk of stroke

Question 14

UW. step-wise approach. not resolved after all drug therapy?

Answer 14

an intrauterine balloon tamponade can be used

Question 15

UW. step-wise approach. not resolved after an intrauterine balloon tamponade?

Answer 15

patients with PPH refractory to medical and minimally invasive techniques require either uterine artery embolization or surgical management with laparotomy (and possible hysterectomy).

Question 16

UW. For what is used Dilation and curettage if PPH?

Answer 16

for PPH due to retained products of conception

Although this patient’s (case) placenta was extracted in pieces, an ultrasound revealed no evidence of retained products of conception (eg, a thin endometrial stripe).

Question 17

UW. when used sterile gauze?

Answer 17

to apply pressure to bleeding vaginal mucosa (eg, after vaginal sulcal laceration repair) to allow for clot formation

Question 18

UW. kita table for PPH. retained products. risk facotrs?

Answer 18

succenturiate placenta
manual extraction of placenta
Hx of previous uterine surgey

Question 19

UW. kita table for PPH. retained products. CP?

Answer 19

enlarged, boggy uterus

Placenta missing cotyledons

RETAINED PLACENTAL FRAGMENTS ON UG

Question 20

UW. kita table for PPH. retained products. Mx?

Answer 20

Manual extraction

Question 21

UW. kita table for PPH. genital trauma. Risk factors?1

Answer 21

operative vaginal delivery

Question 22

UW. kita table for PPH. genital trauma. examination 2

Answer 22

laceration of cervix or vagina

enlarging hematoma

Question 23

UW. kita table for PPH. genital trauma. Mx?

Answer 23

Laceration repair

Question 24

UW. kita table for PPH. inherited coagulopathy. risk factors?

Answer 24

Hx of abnormal bleeding in patients of family members

Question 25

UW. kita table for PPH. inherited coagulopathy. examination?

Answer 25

Continued bleeding despite contracted uterus

Question 26

UW. kita table for PPH. inherited coagulopathy. Mx?

Answer 26

correction of coagulopathy

Question 27

UW. buvo case su vWD. Pagimde pries 2 sav, turi kraujavima from os. aPTT normal, plt normal, PT normal, prolonged bleeding time. WHY aPTT NORMAL? mild-moderate disease

Answer 27

Patients with mild to moderate VWF deficiency may have adequate factor VIII levels to maintain aPTT within normal range (most common reason).

Question 28

UW. buvo case su vWD. Pagimde pries 2 sav, turi kraujavima from os. aPTT normal, plt normal, PT normal, prolonged bleeding time. WHY aPTT NORMAL? inflammation/stress

Answer 28

VWF and factor VIII are acute-phase reactants; inflammation and stress (eg, hemorrhage) can acutely raise levels.

Question 29

UW. buvo case su vWD. Pagimde pries 2 sav, turi kraujavima from os. aPTT normal, plt normal, PT normal, prolonged bleeding time. WHY aPTT NORMAL? hormones/pregnancy

Answer 29

* VWF synthesis is increased by estrogen and thyroid hormones; pregnancy, oral contraceptives, and thyroid hormone replacement can raise VWF levels and normalize aPTT.

Question 30

UW. buvo case su vWD. diagnostic studies?

Answer 30

Diagnostic studies include VWF antigen level, VWF activity (ristocetin cofactor activity), and factor VIII levels.

Question 31

UW. buvo case su vWD. if bleeding does not stop, what drug to Mx?

Answer 31

Desmopressin (DDAVP) potentiates the release of VWF from endothelial cells and can be used in the management of acute bleeding or for prophylaxis.

Question 32

UW. vWD vs vaginal hematoma'?

Answer 32

Vaginal hematoma typically presents with hypotension and anemia due to concealed bleeding into the retroperitoneum. In addition, patients have severe vaginal pain and a vaginal mass on examination. This patient has a normal pelvic examination.

Question 33

UW. Educational objective: Patients with von Willebrand disease may have postpartum hemorrhage and prolonged bleeding time. Activated PTT may be normal or prolonged, and platelet count and PT are normal. Treatment of acute bleeding includes desmopressin.

Answer 33

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