Postpartum Hemorrhage Review Questions with complete Solutions Graded A+

Postpartum Hemorrhage Review Questions with complete Solutions Graded A+ Refers to excessive blood loss during or after the _________ stage of labor. - Answers postpartum hemorrhage, third Normal blood loss is _____ ml for vaginal delivery and ______ ml for CS. - Answers 500 mL, 1,000 mL Leading cause of maternal mortality. - Answers postpartum hemorrhage Most dangerous time at which hemorrhage is likely to occur is during the ____________________. - Answers first hour postpartum. Classification of Postpartum Hemorrhage that occurs at the 1st 24 hours after delivery. - Answers EARLY OR PRIMARY Classification of Postpartum Hemorrhage that occurs from 1st 24 hours to 6 weeks postpartum - Answers LATE OR SECONDARY Retained placenta (not delivered within _________ after birth of baby) - Answers 30 minutes Refers to failure of the uterine myometrial muscle fiber to contract and retract. - Answers Tone Collectively, macrosomia, hydramnios, multiple pregnancy falls under? - Answers Overdistention Collectively, prolonged labor, precipitate labor, oxytocic drugs, falls under? - Answers Fatigue Inhibition of contractions by drugs include the following medications: - Answers anesthesia agents, MgSO4, Nifedipine Collectively, chorioamnionitis, endomyometritis, septicemia, falls under? - Answers Infections TRUE OR FALSE: Placental site in the upper uterine segment affects the tone. - Answers FALSE: Placental site in the lower uterine segment Presence of retained placental tissues prevents uterine contractions resulting to failure to seal off bleeding vessels. - Answers Tissue In tissue, there is a presence of __________ or ___________. - Answers succenturiate or accessory lobe In tissue, preterm gestation is involved. Especially in less than _________ gestation - Answers 24 weeks Abnormal adhesion includes ____________, _________________, and ______________. - Answers Accreta, increta and percreta. __________ of postpartum hemorrhage is due to trauma anywhere in the genital tract - Answers 20% Clot formation on placental site stops oozing of blood from uterine blood vessels. Disorders of the coagulation system and platelets, whether preexistent or acquired, can result in bleeding or aggravate bleeding. - Answers Thrombosis Thrombocytopenic purpura is an example of? - Answers Preexistent coagulation disorder HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelet count), DIC are examples of? - Answers Acquired disorders Clotting factors are significantly reduced with aggressive transfusion of crystalloid and Packed Red Blood Cells (PRBC). - Answers Dilutional coagulopathy _______________ - determine consistency, size and position - Answers Palpate fundus _________________ - for continuous oozing of blood and hematoma formation. - Answers Inspect vagina and perineal area _________________ weigh perineal pads, check blood pool under the hips. - Answers Monitor blood loss per vagina Monitor VS: _________ and ___________. - Answers PR & BP _____________ & _____________ are the most significant signs in hemorrhage. - Answers Tachycardia, Hypotension ↓ urine output signifies _____________ - Answers ↓ blood supply to vital organs. Assess tissue perfusion and oxygen saturation via __________________. - Answers pulse oximetry. altered LOC that occurs with shock is due to - Answers ↓ blood supply to brain. In lab work, CBC is requested. These two components are important. - Answers Hgb and Hct To detect causes of hemorrhage (retained placental fragments and occult hematoma - Answers UTZ _____________________ is done when embolization of bleeding vessels is to be performed. - Answers Angiography This position improves venous return. - Answers Trendelenburg Keep warm by providing ___________. - Answers extra blanket Two IV lines as ordered - 1 for ____________________, 1 for ____________________. - Answers fluid and drugs, possible blood transfusion. Blood transfusion is often required if estimated blood loss is ______________________. - Answers 2,000 ml Packing prevents bleeding by _____________________. - Answers Tamponade effect. _____________________ and ________________ is administered. Packing is removed after ______________. - Answers Prophylactic antibiotics, oxytocin, 24-36 hours. Signs of concealed hemorrhage (2). - Answers hypotension and tachycardia Monitor possible infection (_________ and ______________) - Answers fever and foul vaginal discharge Refers to the failure of the uterus to contract continuously after delivery. Most common cause of PPH. - Answers UTERINE ATONY Uterine relaxing agent. - Answers anesthesia, analgesia, terbutaline, MgSO4 These interfere with uterine contractions - Answers Presence of fibroid tumors Results in very strong uterine contractions and eventual fatigue - Answers Over massage of the uterus Blood normally clots within ______________ - Answers 5 minutes If fails to clot within ___________ - clotting defect. - Answers 7 minutes _______________ to stimulate uterine contractions and to express clots that have accumulated in the uterus or vagina. - Answers Massage uterine fundus Causes very strong uterine contractions, too painful for patient - Answers Forceful uterine massage ______________ is the most common cause of displaced fundus (to the side) - Answers Distended Bladder Make the newly delivered woman void every ___________. If unsuccessful, catheterize with doctor's order - Answers 2 hours Administer __________ to stimulate uterine contractions. - Answers uterotonics ___________ 1st drug of choice for postpartum uterine atony. Also known as________________ - Answers Oxytocin, Methylergonovine Maleate Place ________ on the _______ and make it go down as far as possible behind the uterus. Place _________ flat on the abdomen between the ________ and the ____________. Press hands toward each other to compress uterus, thereby sealing blood vessels at the placental site. Process is known as? - Answers left hand, fundus, right hand, umbilicus and the symphysis pubis. External bimanual compression. 1 hand massages ___________ aspect of uterus through abdomen, other hand massages the ___________ through vagina. Continue compression until bleeding is controlled and uterus contracts. Uterus is raised from pelvis, compressed between hands to expel clots & decrease bleeding Physician may administer analgesia / anesthesia to reduce discomfort associated with bimanual compression, may insert uterine packing to control bleeding. Process is known as? - Answers posterior, anterior fornix Internal bimanual compression and massage 1 hand applies pressure above ________ slightly to the __________, other 1 palpates ____________. Apply pressure on ____________ until __________ is no longer felt. Process is known as? - Answers umbilicus, left, femoral pulse, abdominal aorta, femoral pulse Manual compression of the aorta Last resort if bleeding cannot be controlled. - Answers Hysterectomy Results from over stretching / too rapid stretching of tissues, especially if poorly extensile & rigid - Answers LACERATIONS Irregular tearing caused by blunt object. - Answers LACERATIONS Associated value with macrosomia - Answers (↑ 9 lbs) This position is associated with lacerations. - Answers Lithotomy position Limited to vaginal mucosa and skin of the introitus. - Answers First Degree