ACOG Postpartum Hemorrhage Questions & Answers Solved 100% Correct!!

Maternal hemorrhage is defined as - cumulative blood loss greater than or equal to 1000 mL OR blood loss accompanied by signs or symptoms of hypovolemia within 24 hoursafter the birth process (regardless of route) Leading cause of maternal mortality - PPH (requiring transfusion) Secondary sequelae from PPH - ARDS, shock, DIC, acute renal failure, loss of fertility, and Sheehan syn Despite new definition blood loss greater than ____ after a vaginal delivery is abnormal - 500 mL First step: - ID source of hemorrhage -uterine -cervical -vaginal -periurethral -periclitoral -perineal -perianal -rectal (PE) Primary vs secondary - Primary within 24 hours of birth, secondary >24 h and up to 12 wks postpartum Helpful way to evaluate a bleeding patient - 4 Ts -Tone-Trauma -Tisse -Thrombin Leading cause of PPH - Uterine atony (70-80%) Interventions for uterine atony - massage, bimanual compression, uterotonic drugs MAternal truama includes - lacerations, expanding hematomas, uterine rupture "Tissue" means/how to evaluate - retained placenta/BSUS Risk Factors for PPH: atony - prolonged use of oxytocin High parity Chorio General anesthesia Multiple gestation Polyhydramnios Macrosomia Multiple uterine fibroids Excessive umb cord traction Short umb cord Fundal implantation of placenta RF for trauma - op vag delivery precipitous delivery RF for retained placental tissue - succcenturiate placentaprevious uterine surgery incomplete placenta at delivery RF for coag abnormalities - abnormal bruising petichia fetal death placental abruption fever,sepsis hemorrhage Current thromboembolism treatment When atony is suspected what are your first steps? - Empty the bladder Bimanual exam with clot removal Uterine massage Uterotonics - Oxytocin 3-25% of cases require 2nd: methylergonovine 15-methyl PGF2a Misoprostol If the fundus is firmbut the lower segment is dilated and atonic... - manual clot removal, bimanual compression while waiting for uterotonics to work If a uterine artery lacteration is suspected what should you consider - IR or surgical exploration and ligation Symptoms of geital tract trauma - Labial, rectal, pelvic pressure or pain, or VS deterioration may be the only sign, may not be recognized until hours afterReatined placental tissue is unlikely when US shows - normal endometiral stripe Retained placenta is suspicious when US shows - echogenic mass within uterus First steps when retained placenta suspected - manual extraction Then banjo curetter or large oval forceps