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    Obstetric Hemorrhage

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    b3djo_76
    A 32-year-old woman, gravida 2 para 1, presents at 36 weeks with bright red vaginal bleeding. Her differential diagnosis includes placenta previa, uterine rupture, placental abruption, vasa previa, and vaginal laceration. Placenta previa is identified on ultrasound, with the placenta located anteriorly and free of the cervical os. The patient's bleeding increases and her vital signs deteriorate. Management of postpartum hemorrhage is discussed, including fluid resuscitation, blood products, and treating potential causes like uterine atony, inversion, or lacerations.

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    Obstetric Hemorrhage

    Uploaded by

    b3djo_76
    75 views14 pages
    A 32-year-old woman, gravida 2 para 1, presents at 36 weeks with bright red vaginal bleeding. Her differential diagnosis includes placenta previa, uterine rupture, placental abruption, vasa previa, and vaginal laceration. Placenta previa is identified on ultrasound, with the placenta located anteriorly and free of the cervical os. The patient's bleeding increases and her vital signs deteriorate. Management of postpartum hemorrhage is discussed, including fluid resuscitation, blood products, and treating potential causes like uterine atony, inversion, or lacerations.

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    A 32-year-old woman, gravida 2 para 1, presents at 36 weeks with bright red vaginal bleeding. Her differential diagnosis includes placenta previa, uterine rupture, placental abruption, vasa previa, and vaginal laceration. Placenta previa is identified on ultrasound, with the placenta located anteriorly and free of the cervical os. The patient's bleeding increases and her vital signs deteriorate. Management of postpartum hemorrhage is discussed, including fluid resuscitation, blood products, and treating potential causes like uterine atony, inversion, or lacerations.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    75 views14 pages

    Obstetric Hemorrhage

    Uploaded by

    b3djo_76
    A 32-year-old woman, gravida 2 para 1, presents at 36 weeks with bright red vaginal bleeding. Her differential diagnosis includes placenta previa, uterine rupture, placental abruption, vasa previa, and vaginal laceration. Placenta previa is identified on ultrasound, with the placenta located anteriorly and free of the cervical os. The patient's bleeding increases and her vital signs deteriorate. Management of postpartum hemorrhage is discussed, including fluid resuscitation, blood products, and treating potential causes like uterine atony, inversion, or lacerations.

    Copyright:

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    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 14

    Obstetric Hemorrhage

    Abike James MD Assistant Clinical Prof. Obstetrics and Gynecology University of Pennsylvania

    Third Trimester Bleeding


    A 32 yo G2P1 presents at 36 weeks complaining of bright red vaginal bleeding. Upon further questioning she does admit to having had some light bleeding on 1 to 2 occasions last week. Her previous pregnancy was delivered at term by a Classical Cesarean Section for footling breech presentation.

    Differential Diagnosis?
    Placenta Previa Uterine Rupture Placental Abruption Vasa Previa Laceration Vaginal mass

    Placenta Previa
    Painless third-trimester bleeding Complicates 4-6% pregnancies between 10 and 20 wks, 0.5% pregnancies >20 weeks Risk factors
    Increasing parity, maternal age, prior c/s, curettages for sabs/tabs

    Placental tissue overlying the internal os. Types?


    Complete previa (20-30%) Partial previa (does not completely cover) Marginal (proximate to os)

    Management: pelvic rest, u/s, IV, T+S, C/S

    Associated Conditions
    Placenta accreta, increta, percreta
    Risk inc w/ inc no. of prior c/s (50% risk in pt w/ previa and 2 prior c/s)

    Vasa Previa
    Vessels traverse the membranes in the lower uterine segment in advance of the fetal head. Rupture can lead to fetal exsanguination

    Uterine Rupture
    Associated with Prior c/s Rates of uterine rupture?
    Spontaneous rupture (no c/s history): 1/2000 (0.05%) Low Transverse: 0.5%-1%risk rupture, VBAC 80% success rate Classical C/s: 10% risk rupture, schedule amnio/c/s ~37 weeks.

    Placental Abruption
    Premature separation of placenta Painful third-trimester bleeding Risk Factors
    smoking, trauma, HTN cocaine, pprom, polyhydramnios, multiples

    Trauma evaluation
    bleeding, contractions, abdominal pain and NRFHT in 4hrs

    U/s misses up to 50% of abruptions Management: IV, T+X, Continuous monitoring, c/s vs. vag delivery

    Case Contd
    U/s reveals active, vertex fetus. Placenta anterior and free of os. Pt having contractions q 2-3 minuters. Bleeding increases. BP drops from 110/60 to palpable systolic pressure of 70. FHT drops from 120 to 90 bpm. What do you do???

    Post Partum Hemorrhage


    A 34yo G6P6 patient at term has just delivered a 4000gm infant after second stage of labor lasting 3 hours. The placenta delivered spontaneously and the patient is bleeding briskly. What is average EBL w/ SVD?
    500cc

    What is average EBL w/ C/S?


    1000cc

    Classes of Hemorrhage
    Class 1
    <900cc Minimal symptoms

    Class 2
    1200-1500cc Tachycardia, tachypnea

    Class 3
    1800-2100cc Overt Hypotension, cold, clammy skin

    Class 4
    2400cc Shock, absent BP

    Management
    Fluids
    Crystalloid, open wide/bolus

    Labs
    Cbc, coags, fibrinogen

    Transfuse PRPCs FFP


    Larger vol (250cc/unit, all coagulation factors)

    Cryopercipitate
    Smaller volume (20cc/unit, many coagulation factors)

    Differential Diagnosis
    Atony Uterine inversion Laceration (cervical, vaginal) Retained Placenta

    Uterine Atony
    Risk factors
    multiparity, multiple gestation, macrosomia, abruption, retained POCs, placenta previa, induction (prolonged pitocin)

    Management
    Bimanual exam/massage IV acess/fluids Oxytocin, methergine 0.2mg IM, Hemabate 250mcg IM, misoprostol 800 to 1000mcg rectally

    Laparotomy
    Uterine artery ligation B Lynch Hysterectomy

    UAE

    Uterine Inversion
    Inverted fundus extends beyond cervix (looks beefy red) Stop pitocin if infusing Replace uterus Relaxants if necessary (terbutaline, MgSo4, Nitrogylcerin) Anesthesia Laparotomy

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