| Why is it so bloody? | Meds and More | Meds and More | Potpourri |
|---|---|---|---|
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Vaginal delivery: >500cc
C/S: >1000cc ACOG: Cumulative blood loss > or equal to 1,000cc with signs of hypovolemia within 24hr of delivery
How did ACOG traditionally define postpartum hemorrhage?
Bonus: What's the new definition? (PB 183) |
Carboprost (Hemabate)
15-methyl PGF2alpha 0.25mg IM q15-90 min Will cause bronchospasm in asthmatic
Uterotonic. Gives you bad diarrhea and shouldn't be used in asthmatics. What am I?
Resident: What's the dose? Interval to next dose? |
B-Lynch sutures
Name of the "back-pack" sutures aka compression sutures placed on the uterus.
Bonus: How do you place them? Picture available if you need a hint! |
Microcytic, dilutional affect of increasing plasma volume and erythrocyte mass. Increased Iron requirement
The usual "anemia of pregnancy" is classified as this and caused by what?
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Tone
Trauma (lacs!) Tissue (ie retained placenta) Thrombin (coagulopathy)
What are the 4 T's of PPH? Which is the most common cause?
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Methylergonovine (Methergine)
Acts on directly to contract smooth muscle 0.2mg IM every 2-4 hours HTN, Raynaud's (vascular or CV disorders)
Your patient (19yo now G1P1) continues to bleed but reached for her (surprise!) albuterol inhaler as you were calling for Hemabate. What's your next med?
Route and dose? Interval time to next dose? Contraindications? |
Bakri balloon--filled with 300-500cc of saline; one study showed 85% of women who had one placed needed no further uterotonic or intervention
Combat Gauze--activates Factor XII, coagulation cascade and clotting process; has Kaolin on it, hemostatic agent
Two other forms of mechanical tamponade other than the Jada. Do we have them at Parkland?
(Pictures available for hints if you need them!) |
Paragard, 5 days s/p unprotected intercourse
EC method not affected by patient's body weight
*Bonus--time frame?* |
|
Tone--Chorio, long induction, high parity
Trauma-- Operative vaginal delivery, precipitous delivery Tissue--placental abnormalities, uterine anomalies Thrombin--SPE, thrombophilia, DIC (bleeding and bruising problem!)
Name a risk factor for each of the T's.
|
Misoprostol 1000mcg rectally
PGE1
We've given an initial uterotonic but some bleeding is still happening. You're going to look for other reasons for bleeding but what other medication can we give?
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Massive Transfusion Protocol
pRBC, FFP (expand volume), Cryoprecipitate (rich in clotting factors especially fibrinogen!), platelets
You're out on L&D and call into the OR to check-in. You hear someone say "Activate MTP". What is this? What products are a usual part of this protocol?
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What are HIGH risk factors for SPE
Prior pregnancy w/preeclampsia, Multifetal gestation, Renal Disease, AI Disease, T1 or T2 DM, cHTN
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Uterine atony
Causes 70-80% of postpartum hemorrhage
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What is a Jada
Intrauterine vacuum device--seal against cervix; low continuous suction causes contraction down https://www.thejadasystem.com/how-jada-system-works/
Med Student: What is this?
Resident: How does it work? |
Uterine artery embolization
Must be STABLE!
IR is called to help. What procedure are they going to do? What are the requirements?
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Tx, leave IUD in place
Do not place if known + result, cervicitis or purulent discharge
IUD placed --> +CT, what next?
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Pitocin
Uterine massage Gentle traction on umbilical cord Yes, but limited data.
What is the active management of the third stage of labor? Does it help reduce PPH?
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Communicate with Anesthesia, Nursing, upper levels/faculty
Move to OR--what are we setting up for? IV access Baseline labs Ordering blood products
Things aren't going great. Still bleeding and patient is starting to get hypotensive. What do you want to do next?
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Untreated uterine inversion or rupture
Known cervical cancer Known uterine anomaly Active purulent infection to cervix/uterus/vagina C/S: cervix <3cm dilated prior to placement of Jada
What are the contraindications to a Jada placement?
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Shark, swordfish, king mackerel, tilefish, bigeye tuna, marlin, orange roughy
Name 3 high mercury fish types to avoid during pregnancy
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