Postpartum hemorrhage (PPH) KEY Mandatory Questions and CORRECT Answers

most common cause of postpartum hemorrhage - uterine atony Where does detachment of the placenta normally occur first from the uterine wall? - starts at center and works its way toward the periphery How is the uterine bleeding stopped after the placenta detaches - "criss-crossing" muscle cells encircling the maternal spiral arteries contract post-partum hemorrhage - delivery-associated blood loss in excess of *500mL* for a vaginal delivery and in excess of *1,000 mL* for a c/s primary (early) PPH - within 25 hours of delivery secondary (late) PPH - occurs 24 hours but within 12 weeks after delivery ("saturating a pad within an hour") Is early or late post-partum hemorrhage more worrisome? - early prevalence of post-partum hemorrhage - 4% At what percent of blood loss in PPH, will a woman start developing signs? - 20% clinical signs of 10-15%, 20%, 30%, and 40-50% blood loss with PPH - 10-15%: no signs 20%: tachycardia, delayed capillary refill, orthostatic changes, narrowed pulse pressure 30%: breathing and HR further increases, overt hypotension develops 40-50%: oliguria, shock, coma...death 4 T's that can cause early postpartum hemorrhage - 1. tone 2. trauma 3. tissue 4. thrombin (failure of blood to clot normally)