Why is it so bloody? Meds and More Meds and More Potpourri
100
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)
100
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?
100
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!
100
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?
200
Tone
Trauma (lacs!)
Tissue (ie retained placenta)
Thrombin (coagulopathy)
What are the 4 T's of PPH? Which is the most common cause?
200
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?
200
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!)
200
Paragard, 5 days s/p unprotected intercourse
EC method not affected by patient's body weight
*Bonus--time frame?*
300
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.
300
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?
300
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?
300
What are HIGH risk factors for SPE
Prior pregnancy w/preeclampsia, Multifetal gestation, Renal Disease, AI Disease, T1 or T2 DM, cHTN
400
Uterine atony
Causes 70-80% of postpartum hemorrhage
400
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?
400
Uterine artery embolization
Must be STABLE!
IR is called to help. What procedure are they going to do? What are the requirements?
400
Tx, leave IUD in place
Do not place if known + result, cervicitis or purulent discharge
IUD placed --> +CT, what next?
500
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?
500
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?
500
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?
500
Shark, swordfish, king mackerel, tilefish, bigeye tuna, marlin, orange roughy
Name 3 high mercury fish types to avoid during pregnancy






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