Postpartum Hemorrhage Essay
Postpartum Hemorrhage
Jorge Garcia, MD
December, 2001
Outline
Case History
Definition
Rapid diagnosis
Treatment
Review risks
Case History.
Healthy 32 yo G2P1+0.
Previous C/S 2 years back
Augmented vaginal delivery with vacuum extraction, with episiotomy
On admission uterus will contracted. Lochia normal
Second day Patient complaining of continues sever pain prescribed as pressure on the rectum side which was not relieved by analgesia. Lochia was minimal, episiotomy site is clear.
Glycerin Suppository inserted
Patient called she started bleeding per vagina.
Upon fundal palpation; Atony in left lateral position
Speculum used to examine vagina, bleeding increase. Clots noted
Tachycardiac, BP maintained. Syntocine …show more content…
Simultaneous evaluation and treatment.
Remember ABCs.
Use O2 4L/min.
If bleeding does not readily resolve, call for help. Start two 16g or 18g IVs.
ALSO’s 4 Ts
Tone (Uterine tone)
Tissue (Retained tissue--placenta)
Trauma (Lacerations and uterine rupture)
Thrombin (Bleeding disorders)
“Tone: Think of Uterine Atony”
Uterine atony causes 70% of hemorrhage
Assess and treat with uterine massage
Use medication early
Consider prophylactic medication...
Bimanual Uterine Exam
Confirms diagnosis of uterine atony.
Massage is often adequate for stimulating uterine involution.
Medications for Uterine Atony
1. Oxytocin promotes rhythmic
contractions.
Give IM or IU, not IV. (Can cause BP)
40U/L at 250cc/h.
2. Methergine 0.2mg (1 amp) IM
3. Hemabate 0.25mg IM q 15min (max
X8).
Medications: Methergine
Causes tetanic uterine contraction.
May trap placenta.
Can cause Hypertension, especially IV.
Contraindicated in hypertensive patients and those with pre-eclampsia.
Prostaglandin F2 15-methyl
Hemabate 0.25mg IM or IU.
Used to be called
Jorge Garcia, MD
December, 2001
Outline
Case History
Definition
Rapid diagnosis
Treatment
Review risks
Case History.
Healthy 32 yo G2P1+0.
Previous C/S 2 years back
Augmented vaginal delivery with vacuum extraction, with episiotomy
On admission uterus will contracted. Lochia normal
Second day Patient complaining of continues sever pain prescribed as pressure on the rectum side which was not relieved by analgesia. Lochia was minimal, episiotomy site is clear.
Glycerin Suppository inserted
Patient called she started bleeding per vagina.
Upon fundal palpation; Atony in left lateral position
Speculum used to examine vagina, bleeding increase. Clots noted
Tachycardiac, BP maintained. Syntocine …show more content…
Simultaneous evaluation and treatment.
Remember ABCs.
Use O2 4L/min.
If bleeding does not readily resolve, call for help. Start two 16g or 18g IVs.
ALSO’s 4 Ts
Tone (Uterine tone)
Tissue (Retained tissue--placenta)
Trauma (Lacerations and uterine rupture)
Thrombin (Bleeding disorders)
“Tone: Think of Uterine Atony”
Uterine atony causes 70% of hemorrhage
Assess and treat with uterine massage
Use medication early
Consider prophylactic medication...
Bimanual Uterine Exam
Confirms diagnosis of uterine atony.
Massage is often adequate for stimulating uterine involution.
Medications for Uterine Atony
1. Oxytocin promotes rhythmic
contractions.
Give IM or IU, not IV. (Can cause BP)
40U/L at 250cc/h.
2. Methergine 0.2mg (1 amp) IM
3. Hemabate 0.25mg IM q 15min (max
X8).
Medications: Methergine
Causes tetanic uterine contraction.
May trap placenta.
Can cause Hypertension, especially IV.
Contraindicated in hypertensive patients and those with pre-eclampsia.
Prostaglandin F2 15-methyl
Hemabate 0.25mg IM or IU.
Used to be called