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Post partum hemorrhage LB
- 2. Outline ■ Introduction : Definition and basic overview ■ Normal physiology post-partum ■ Sx and Dx ■ Etiology : “The 4T’s” ■ Risk Factors ■ General Management ■ Most common causes ■ References
- 3. Definition ■ A significant amount of blood loss post-partum (after delivery) that presents with symptoms or signs of low blood volume. ■ >500 ml with vaginal delivery or >1000 ml with a C-section (subj.) ■ > 10% decrease in hemoglobin or hematocrit (obj.)
- 4. Overview
- 6. Sx ■ Heavy vaginal bleeding ■ Hypovolemia Hypovolemic shock Dizzy Lightheaded confused Dx ■ Mostly limited to PE initially Palpate the uterus • Increased size • Reduced muscle tone
- 7. Detection of Blood loss ■ 10%-15% loss (500 mL): no signs/symptoms ■ 20 %: tachycardia, tachypnea, delayed capillary refill, orthostatic changes, narrowed pulse pressure (due to elevated diastolic pressure from vasoconstriction to maintain systolic pressure) ■ 30% +: tachycardia/tachypnea worsen, overt hypotension ■ 40%-50%: profound blood loss: oliguria, shock, coma, and death
- 8. Etiology ■ The fourT’s: Tone Trauma Tissue Thromobosis
- 21. Risk Factors ■ Prolonged labor ■ Augmented labor ■ Rapid labor ■ Hx of prior hemorrhage ■ Episiotomy ■ Preeclampsia ■ Over distended uterus (macrosomia, multiple gestation, polyhydramnios) ■ Operative delivery ■ Ethnicity (Asian, Hispanic)
- 22. Most common causes: ■ Uterine atony (80%) ■ Retained placenta ■ Genital tract trauma (e.g., laceration) ■ Coagulation disorder ■ Hematoma ■ Uterine inversion ■ Uterine rupture
- 23. General management ■ Management facilitated if high-risk patients identified and preparations made occur prior to bleeding ■ Before delivery i. Baseline hematocrit ii. Blood type and screen (cross match for high risk) iii. IV access iv. Baseline coagulation tests and platelets if indicated v. Assessment of risk factors
- 24. ■ Delivery room i. Excess umbilical cord traction avoided ii. Judicious use of forceps/vacuum iii. Inspection of placenta for complete removal iv.Active management of 3rd stage v.Visualization of cervix/vagina vi. Removal of clots from uterus/vagina prior to transfer to recovery
- 25. ■ After delivery i. Observation of patient for excessive bleeding ii. Frequent palpation/massage of uterus iii.Vital signs frequently monitored
- 30. References ■ Danforth'sObstetrics and Gynecology 10th ■ Step-up to obstetrics and gynecology / [edited by] FrankW. Ling, Russell R. Snyder, SandraAnn Carson,Wesley C. Fowler. — 1st edition ■ Postpartum hemorrhage - Reproductive system physiology - NCLEX-RN - Khan Academy ■ Osmosis.org : Postpartum hemorrhage - causes, symptoms, treatment, pathology
- 31. Thank you for listening…… ……and your welcome!
Notas del editor
- 1. Symptoms: fatigue, light headedness, confusion, sweat, paleness Signs of low blood volume: hypotension, tachycardia, low urine output 2. Studies have shown practitioners tend to underestimate blood loss Not really easy to actually measure blood loss 3. Can anyone tell me what limitations there could be with the last definition? It takes time to manifest in lab values=delayed treatment
- 2nd and 3rd:
- The placenta separates from the uterus and leaves the blood vessels broken and ruptured. The myometrium starts to contract and retract ,constricting the vessels. Arranged as a lattice structure. Then coagulation is activated.
- Reduced muscle tone: Boggy, spongy, flaccid uterus
- abortions