POSTPARTUM HEMORRHAGE CORE MAIN EXAMS
ALL QUESTIONS AND ANSWERS SURE A+
✔✔How can early PPH be prevented during labor? (7) - ✔✔1. use forceps and vacuum
judiciously (avoid intraoperative vaginal delivery)
2. avoid excessive traction on umbilical cord
3. inspect placenta for complete removal
4. give oxytocin to contract uterus just after delivery (decreases risk by 50%)
5. visualize cervix and vagina after deilvery
6. digitally explore the uterus if indicated
7. perform uterine massage to stimulate contraction of the uterus
✔✔How can early PPH be prevented after delivery? (4) - ✔✔1. closely observe for
excessive bleeding
2. continue oxytocin via IV if bleeding
3. frequently palpate uterus
4. frequently determine vital signs
✔✔What sometimes is the only clue of PPH? - ✔✔change in hemodynamic status
✔✔What should you do if you have a pt in PPH? - ✔✔1. notify the obstetric hemorrhage
team
2. maintain circulation
, 3. identify cause
4. treat cause
✔✔methods to maintain circulation in PPH - ✔✔1. establish IV circulation w/ 2 large
bore IVs
2. order blood and blood products
3. begin crystalloid infusion until blood and blood products arrive
4. check CBC, platelets, INR/PTT/fibrinogen level
✔✔How can you determine the cause of the PPH? (4) - ✔✔1. palpate the uterus via
bimanual exam to check for atony (will feel boggy)
2. inspect placenta to make sure all of it was delivered
3. inspect cervix, vagina, vulva, and perineum for lacerations and hematomas
4. palpate the uterine wall for rupture/hematomas/retained placenta (can also use U/S)
✔✔treatment for uterine atony (5) - ✔✔1. bimanual uterine massage (usually enough)
2. uterotonic pharmacologic agents
3. intrauterine balloon packing
4. transfusion if necessary
5. surgery
✔✔pharmacologic agents for uterine atony (6) - ✔✔1. oxytocin IV drip
2. uterotonic pharmacologic agents
3. tranexamic acid
4. 15-methyl PGF2-alpha
5. methylethylergonavine
6. misoprosotol
✔✔tranexamic acid - ✔✔inhibits conversion of plasminogen to plasmin (not a
uterotonic)
✔✔surgical measures for uterine atony leading to PPH (4) - ✔✔1. uterine compression
sutures
2. arterial embolization
3. sequential arterial ligation
4. hysterectomy as a last resort
✔✔B-lynch suturing - ✔✔compresses the uterus, sutures are absorbable
✔✔treatment for a hematoma post-partum - ✔✔<5cm - can watch via vital signs and
urinary output
>5cm (or enlarging) - surgical management
✔✔Why do you check urinary output when watching a hematoma post-partum? -
✔✔make sure it's not compressing the bladder/urethra
ALL QUESTIONS AND ANSWERS SURE A+
✔✔How can early PPH be prevented during labor? (7) - ✔✔1. use forceps and vacuum
judiciously (avoid intraoperative vaginal delivery)
2. avoid excessive traction on umbilical cord
3. inspect placenta for complete removal
4. give oxytocin to contract uterus just after delivery (decreases risk by 50%)
5. visualize cervix and vagina after deilvery
6. digitally explore the uterus if indicated
7. perform uterine massage to stimulate contraction of the uterus
✔✔How can early PPH be prevented after delivery? (4) - ✔✔1. closely observe for
excessive bleeding
2. continue oxytocin via IV if bleeding
3. frequently palpate uterus
4. frequently determine vital signs
✔✔What sometimes is the only clue of PPH? - ✔✔change in hemodynamic status
✔✔What should you do if you have a pt in PPH? - ✔✔1. notify the obstetric hemorrhage
team
2. maintain circulation
, 3. identify cause
4. treat cause
✔✔methods to maintain circulation in PPH - ✔✔1. establish IV circulation w/ 2 large
bore IVs
2. order blood and blood products
3. begin crystalloid infusion until blood and blood products arrive
4. check CBC, platelets, INR/PTT/fibrinogen level
✔✔How can you determine the cause of the PPH? (4) - ✔✔1. palpate the uterus via
bimanual exam to check for atony (will feel boggy)
2. inspect placenta to make sure all of it was delivered
3. inspect cervix, vagina, vulva, and perineum for lacerations and hematomas
4. palpate the uterine wall for rupture/hematomas/retained placenta (can also use U/S)
✔✔treatment for uterine atony (5) - ✔✔1. bimanual uterine massage (usually enough)
2. uterotonic pharmacologic agents
3. intrauterine balloon packing
4. transfusion if necessary
5. surgery
✔✔pharmacologic agents for uterine atony (6) - ✔✔1. oxytocin IV drip
2. uterotonic pharmacologic agents
3. tranexamic acid
4. 15-methyl PGF2-alpha
5. methylethylergonavine
6. misoprosotol
✔✔tranexamic acid - ✔✔inhibits conversion of plasminogen to plasmin (not a
uterotonic)
✔✔surgical measures for uterine atony leading to PPH (4) - ✔✔1. uterine compression
sutures
2. arterial embolization
3. sequential arterial ligation
4. hysterectomy as a last resort
✔✔B-lynch suturing - ✔✔compresses the uterus, sutures are absorbable
✔✔treatment for a hematoma post-partum - ✔✔<5cm - can watch via vital signs and
urinary output
>5cm (or enlarging) - surgical management
✔✔Why do you check urinary output when watching a hematoma post-partum? -
✔✔make sure it's not compressing the bladder/urethra
