243 Questions
What is the shock index used for in nonpregnant patients?
To measure the level of haemodynamic compromise
How does the shock index compare with conventional vital signs in identifying women at risk of adverse outcomes secondary to PPH?
It is more accurate
What term may be used to define the urgency to the team during major obstetric hemorrhage?
'Controlled major obstetric hemorrhage'
Why must senior obstetric staff be receptive to concerns expressed by less experienced or junior medical practitioners and midwives?
Because it is essential for patient care
What form of words can be used in cases of major obstetric hemorrhage?
'We need compatible blood now'
What is one of the main purposes of employing the shock index?
To serve as an early marker of haemodynamic compromise
How does the shock index compare with other methods in identifying women at risk of adverse outcomes secondary to PPH?
It is more reliable
Why should senior obstetric staff be open to concerns expressed by less experienced medical practitioners and midwives?
Because it is crucial for patient safety
How much cryoprecipitate level 3 is needed to increase the fibrinogen level by about 1 g/l?
1 pool from four donors
What amount of fibrinogen concentrate is required to increase the fibrinogen level by 1 g/l?
60 mg/kg
At what platelet count should platelets be transfused during Postpartum Hemorrhage (PPH)?
Less than 75 × 10^9/l
What is the recommended trigger platelet count for transfusion during ongoing PPH?
50 × 10^9/l
Which treatment is associated with a possible reduced use of Fresh Frozen Plasma (FFP) according to observational studies?
Fibrinogen concentrate
What type of studies are required to confirm the observed outcomes related to fibrinogen infusion?
Randomized controlled trials (RCTs)
Which guideline is referenced in the text for platelet transfusion during Postpartum Hemorrhage?
RCOG Green-top Guideline No. 52
What is one of the causes of secondary PPH mentioned in the text?
Subinvolution of the placental implantation site
How should women presenting with secondary PPH be managed?
Assessment of haemodynamic status and blood loss
What type of testing is recommended for endometritis in patients with secondary PPH?
High vaginal swab
According to Pather et al., what incidence of abnormal vaginal microbiology was found in their case series?
52%
What antibiotic combination was found to be appropriate for treating postpartum endometritis in a Cochrane review?
Clindamycin and gentamicin
What did the Cochrane review conclude about further oral therapy for uncomplicated endometritis after clinical improvement with intravenous therapy?
It has no additional benefit
What was reported as having a low yield of positive results in patients with secondary PPH?
High vaginal swab testing
What role does ultrasound play in making the procedure safer?
Assists in controlling bleeding
When should transfer to an intensive care or high dependency unit be considered?
Depending on the severity of the blood loss
What is the significance of rFVIIa in treating life-threatening PPH?
It can delay life-saving procedures
What is the anaesthetist's role in managing PPH?
Determining and administering the most appropriate method of anaesthesia
Why is it important for rFVIIa not to delay life-saving procedures?
Because early intervention is crucial in life-threatening situations
In managing PPH, what should anaesthetists focus on the most?
Determining the most appropriate method of anaesthesia
What should not be considered a substitute for life-saving procedures in treating PPH?
$rFVIIa$ treatment
$What$ plays a crucial role in making the procedure safer?
$Ultrasound$ usage
What is recommended for women with iron deficiency anaemia who do not respond to oral iron antenatally?
Parenteral iron therapy
What hemoglobin level during pregnancy indicates antenatal anaemia according to the text?
Less than 90 g/l
What is of no benefit in the prophylaxis of postpartum hemorrhage?
Uterine massage
What should be routinely offered in the management of the third stage of labor for all women to reduce the risk of postpartum hemorrhage?
Prophylactic uterotonics
For women without risk factors for postpartum hemorrhage delivering vaginally, what is the agent of choice for prophylaxis in the third stage of labor according to the text?
Oxytocin (10 iu by intramuscular injection)
What dose of oxytocin is unlikely to be beneficial for reducing the risk of postpartum hemorrhage according to the text?
Higher dose
What type of study provided evidence about the association between antenatal anaemia and greater blood loss at delivery and postpartum?
Population-based study
'Minimising risk - reducing blood loss at delivery' was found in which guideline according to the text?
'RCOG Green-top Guideline No. 52'
What is the main advantage of point of care testing using viscoelastometry (TEG and ROTEM) compared to laboratory tests?
Results are known at the same time as laboratory test results
What does NICE conclude regarding the routine adoption of viscoelastometric point of care testing in the management of postpartum hemorrhage?
Insufficient evidence to recommend
What happens if PT/APTT are normal in relation to the requirement of FFP?
FFP is not required
What level of evidence recommends the use of point of care testing with TEG and ROTEM?
Level 4
What should be agreed upon with the haematology laboratory if viscoelastometric point of care testing is used?
Quality control protocol
Why should Clauss fibrinogen be measured as part of the routine coagulation screen?
It falls early and may be reduced to a clinically significant level despite normal PT/APTT.
What is the main limitation of routine coagulation tests like PT and APTT in acute and rapidly evolving bleeds?
Their turnaround times are often too slow to provide clinically useful results.
What is a key advantage of repeated testing every 30 minutes during continued bleeding over single measurements?
It allows observation of trends which are more useful than single measurements.
Why is platelet count measurement essential in the full blood count during coagulation screening?
To identify low platelet levels that can contribute to bleeding disorders.
In what scenario is point of care testing particularly advantageous over traditional laboratory-based coagulation tests?
When immediate results are needed in acute and rapidly evolving bleeds.
When should clinicians administer 4 units of FFP according to the text?
If 8 units of red blood cells have been administered.
What is the recommended dose of FFP if haemorrhage persists after 4 units of red blood cells and haemostatic tests are unavailable?
4 units of FFP
How much cryoprecipitate should be given if haemorrhage persists and fibrinogen level is below 2 g/l?
2 pools of cryoprecipitate
At what platelet count should platelet concentrates be given during ongoing haemorrhage?
$<50$ x $10^9$/l
How much FFP should be given if prothrombin time or activated partial thromboplastin time are prolonged and haemorrhage is ongoing?
$12-15$ ml/kg of FFP
What is the significance of PT/APTT greater than 1.5 times normal in managing postpartum hemorrhage?
It shows that severe and established haemostatic impairment has occurred
What is the drawback of early FFP administration in women with PPH?
Normal coagulation at the time of administration
How should FFP replacement be guided during postpartum hemorrhage according to the text?
By using laboratory and point of care coagulation tests
What volume and aim of FFP infusion is recommended if PT/APTT results are prolonged during ongoing hemorrhage?
12-15 ml/kg aiming for PT/APTT less than 1.5 times normal
When is a larger volume of FFP likely to be required during postpartum hemorrhage?
When PT/APTT results are prolonged
What is the expected increase in fibrinogen level after transfusion of 2 pools of cryoprecipitate level 3?
1 g/l
How much fibrinogen concentrate is required to raise the fibrinogen level by 1 g/l?
60 mg/kg
When should platelets be transfused during Postpartum Hemorrhage based on laboratory monitoring?
Platelet count < 75 9 109/l
What is the consensus about maintaining platelet levels during ongoing Postpartum Hemorrhage to prevent bleeding?
> 50 9 109/l
What is the evidence-based method for determining when platelets should be transfused during Postpartum Hemorrhage?
Laboratory monitoring
When should FFP be infused in the management of postpartum hemorrhage if haemostatic tests are not available and haemorrhage is continuing?
After 4 units of RBCs
In what ratio should RBC to FFP transfusion be maintained until tests of haemostasis are available?
6:4
For which conditions could the empirical use of FFP be considered even before haemostatic tests are available?
Placental abruption
What is the recommended dose of tranexamic acid for the management of postpartum hemorrhage according to the text?
$1 g intravenously over 10 minutes followed by an infusion of 1 g over 8 hours$
Which situation may warrant the consideration of early administration of tranexamic acid in the management of postpartum hemorrhage?
$Placental abruption$
In elective transfusion during the antenatal period, why should CMV-seronegative products be used?
To reduce the risk of CMV transmission to the fetus
When should FFP be considered for conditions suspected to have coagulopathy, such as placental abruption or amniotic fluid embolism?
In the absence of haemostatic test results
What coagulation tests are mentioned as criteria for considering volumes of FFP in excess of 15 ml/kg for ongoing hemorrhage?
PT/APTT more than 1.5 times normal
Why should clinicians order blood components as soon as the need is anticipated?
Because there will be a short delay in supply
When should early FFP be considered for patients with postpartum hemorrhage?
For all cases of postpartum hemorrhage
What type of testing method was specifically searched for in the databases to manage postpartum hemorrhage?
Viscoelastography tests
Which specific protein concentrate was mentioned in the text as part of the searches conducted to manage postpartum hemorrhage?
Fibrinogen concentrate
What is one of the terms included in the search words for managing postpartum hemorrhage that specifically relates to drug treatment?
Syntocinon
Which testing method was highlighted in the search terms for managing postpartum hemorrhage that involves point-of-care evaluation of coagulation?
Viscoelastometric testing
Among the search terms for managing postpartum hemorrhage, which intervention includes a surgical procedure for uterine compression?
Bilateral internal iliac ligation
What type of testing method was NOT specifically searched for in the databases to manage postpartum hemorrhage?
Complete blood count (CBC)
One of the search terms for managing postpartum hemorrhage includes a recommendation for pharmacological treatment. Which term is it?
'Carbetocin'
'DARE', a significant database, is associated with which specific type of literature related to postpartum hemorrhage?
'Systematic reviews'
'B-lynch suture' mentioned in the search terms refers to what type of intervention?
'Surgical procedure'
Which database was NOT included in the search to find relevant articles on postpartum hemorrhage?
CINAHL
What is the drawback of early FFP administration in women with Postpartum Hemorrhage?
Normal coagulation at the time of administration
What is the significance of PT/APTT greater than 1.5 times normal in managing Postpartum Hemorrhage?
Suggests significant haemostatic impairment
What was mentioned as required to rapidly increase fibrinogen level when administering FFP?
Cryoprecipitate or fibrinogen concentrate
When should a larger volume of FFP be likely required during Postpartum Hemorrhage?
If PT/APTT results are prolonged
What type of testing is recommended to guide FFP replacement during Postpartum Hemorrhage?
Laboratory and point of care coagulation tests
If the PT and APTT are normal, what does the text recommend regarding the need for FFP?
FFP should not be given if bleeding persists
What does the NICE (National Institute for Health and Care Excellence) conclude about viscoelastometric point of care testing in managing postpartum hemorrhage?
States there is insufficient evidence for routine adoption
What is recommended by the Obstetric Anaesthetists’ Association/Association of Anaesthetists of Great Britain and Ireland regarding point of care testing in PPH?
Recommends using TEG and ROTEM combined with an agreed treatment algorithm
What level of evidence supports the use of point of care testing with TEG and ROTEM in managing postpartum hemorrhage?
Level 4 evidence
What does RCOG Green-top Guideline No. 52 recommend regarding FFP replacement in ongoing hemorrhage with prolonged PT/APTT?
Avoid FFP in such cases
What is the recommended volume of isotonic crystalloid for clinicians to agree upon before blood transfusion for postpartum hemorrhage?
2 liters
When should administration of fresh frozen plasma (FFP) be guided by during postpartum hemorrhage?
Haemostatic testing
How much fresh frozen plasma (FFP) should be administered if haemorrhage continues after 4 units of red blood cells (RBCs) and haemostatic tests are unavailable?
4 units
When should platelet concentrates be administered during postpartum hemorrhage?
If platelet count is less than 75 x 10^9/l
What factor should guide the administration of cryoprecipitate if haemorrhage is ongoing and fibrinogen level is less than 2 g/l?
Fibrinogen level
Why should Clauss fibrinogen be measured as part of the routine coagulation screen?
It reflects the past hemostatic status of the woman.
What is the main limitation of routine coagulation tests like PT and APTT in acute and rapidly evolving bleeds?
They do not reflect the current hemostatic status.
How much fibrinogen concentrate is required to raise the fibrinogen level by 1 g/l?
$2$ pools of cryoprecipitate
Why is platelet count measurement essential in the full blood count during coagulation screening?
It reflects real-time hemostatic status.
What is the significance of rFVIIa in treating life-threatening PPH?
It should not delay life-saving procedures.
What is the general consensus for platelet transfusion during ongoing Postpartum Hemorrhage?
Transfuse at a trigger of 75 x 10^9/l to maintain a level greater than 50 x 10^9/l.
What is the expected increase in fibrinogen level after transfusion of 2 pools of cryoprecipitate level 3?
Increase by 1 g/l.
What is the requirement of fibrinogen concentrate in mg/kg to raise the fibrinogen level by 1 g/l?
$60 mg/kg$.
When should platelet concentrates be given during ongoing hemorrhage?
At a platelet count of 75 x 10^9/l.
What level should platelets be transfused at to maintain an appropriate level during ongoing Postpartum Hemorrhage?
$50 x 10^9/l$.
In the management of postpartum hemorrhage, what should be considered if tests of hemostasis are not available after 4 units of RBCs have been transfused?
Empirical use of FFP at 12–15 ml/kg
What is the recommended dose of tranexamic acid in the management of postpartum hemorrhage based on evidence from a large RCT?
1 g intravenously over 10 minutes
When should early administration of tranexamic acid be considered in the management of postpartum hemorrhage according to the text?
If placental abruption is suspected
Which situation may warrant the consideration of early FFP administration in postpartum hemorrhage?
Suspected placental abruption
What role does fibrinogen assay play in the management of postpartum hemorrhage according to the text?
Predicting the need for FFP infusion
What type of blood products should be used in elective transfusion during the antenatal period to avoid CMV transmission to the fetus?
CMV-negative products
When should CMV-negative blood or platelets be used for transfusion during delivery or in the postpartum period?
In an emergency, such as PPH
In the absence of haemostatic test results, what is the recommended dose of FFP if bleeding persists after 4 units of red blood cells?
12–15 ml/kg
In conditions with a suspected coagulopathy and ongoing hemorrhage, what triggers the need for volumes of FFP in excess of 15 ml/kg for correction?
PT/APTT more than 1.5 times normal
Why should FFP be considered early for conditions like placental abruption or amniotic fluid embolism?
To correct suspected coagulopathy
What is the significance of searching for the mentioned Medical Subject Headings (MeSH) terms in the databases for managing postpartum hemorrhage?
Assessing hemostatic status
Why was the search for articles restricted to those published between 2007 and September 2015?
To focus on recent developments in managing postpartum hemorrhage
What role do the terms 'carbetocin', 'carboprost', and 'Syntocinon' play in the search strategy for postpartum hemorrhage?
Finding uterotonic agents
Why were the searches limited to humans and the English language?
To ensure relevance to human cases and facilitate understanding of results
What is the primary purpose of searching for terms like 'thromboelastography' and 'thromboelastometry' in the databases for postpartum hemorrhage?
To explore coagulation status dynamically
Why are areas lacking evidence annotated as 'good practice points' according to the text?
To emphasize areas needing further research
What is the primary advantage of using viscoelastometry (TEG and ROTEM) over traditional laboratory tests for coagulation status?
Dynamic assessment of clot formation and strength
Why do organizations like the British Committee for Standards in Haematology Transfusion Taskforce provide recommendations based on available evidence?
To offer guidance backed by research findings
What is the recommended threshold for prothrombin time (PT) in managing massive blood loss?
Less than 1.5 times normal
Why should Clauss fibrinogen be measured as part of the routine coagulation screen?
It falls early and may be reduced to a clinically significant level despite normal PT/APTT.
Why are routine coagulation tests such as PT and APTT not clinically useful in acute and rapidly evolving bleeds?
They reflect the past hemostatic status of the patient.
In the context of managing massive blood loss, what is the suggested platelet count?
Greater than 50 x 109/l
What fibrinogen level is preferred in patients with massive blood loss?
Greater than 2 g/l
What is the primary advantage of measuring platelet count as part of the full blood count?
Platelet number is crucial for evaluating clotting function.
When managing massive blood loss, what activated partial thromboplastin time (APTT) value should be aimed for?
Less than 1.5 times normal
Why is repeated testing every 30 minutes more useful than single measurements during continued bleeding?
Observation of trends is crucial in managing rapidly evolving bleeds.
What makes point of care testing valuable in assessing hemostatic impairment during PPH?
It leads to appropriate use of blood components and can be done simultaneously with laboratory testing.
What is the primary hemoglobin threshold advised in the management of massive blood loss?
Greater than 80 g/l
What is the recommended action if platelet count is less than 75 x 10^9/l during ongoing hemorrhage?
Administer 1 pool of platelets
When should FFP be given in the absence of haemostatic test results and ongoing hemorrhage?
After administering 4 units of RBCs
In the context of Postpartum Hemorrhage, what does the text recommend if fibrinogen level is below 2 g/l?
Administering 2 pools of cryoprecipitate
When should CMV-seronegative products be used in elective transfusions during the antenatal period?
When transfusing in the postpartum period
What would be the appropriate course of action if prothrombin time (PT) or activated partial thromboplastin time (APTT) are prolonged and hemorrhage is ongoing?
Administer 12–15 ml/kg of FFP
What is the main advantage of point of care testing using viscoelastometry such as TEG and ROTEM?
Decreased blood product use
In the management of postpartum hemorrhage, what does the text recommend if PT/APTT are normal?
No FFP required
What is the recommended platelet level for transfusion during ongoing Postpartum Hemorrhage according to the text?
No specific recommendation provided
What is the significance of using point of care testing with TEG and ROTEM in the management of PPH?
Decreased blood loss and blood product use
In patients with suspected coagulopathy and ongoing hemorrhage, what triggers the need for volumes of FFP in excess of 15 ml/kg for correction?
$2 pools of cryoprecipitate level 3
What is the main drawback of early Fresh Frozen Plasma (FFP) administration in women with Postpartum Hemorrhage (PPH)?
Increased risk of transfusion-associated circulatory overload
What is suggested in the text if PT/APTT results are greater than 1.5 times normal during ongoing hemorrhage?
Administer a larger volume of FFP to correct parameters
When does abnormal PT/APTT suggest progression towards significant hemostatic impairment according to the text?
Involvement of severe hemostatic impairment
What should be administered if PT and APTT are prolonged during ongoing hemorrhage, as per the text?
Fresh Frozen Plasma (FFP)
What is required to increase the fibrinogen level rapidly during Postpartum Hemorrhage (PPH), according to the text?
Cryoprecipitate
In elective transfusion during the antenatal period, why should CMV-seronegative products be used?
To avoid transmission of CMV to the fetus
What triggers the need for volumes of FFP in excess of 15 ml/kg during ongoing hemorrhage for correction?
Low fibrinogen levels
Why should Clauss fibrinogen be measured as part of the routine coagulation screen?
To evaluate hemostatic status
What is recommended when hemostatic tests are not available after administering 4 units of RBCs in postpartum hemorrhage?
Consider early administration of tranexamic acid
Why are CMV-negative blood or platelets not needed for transfusion during delivery or in the postpartum period?
Due to universal leucocyte depletion policy
How much fibrinogen concentrate is required to increase the fibrinogen level by 1 g/l?
60 mg/kg
At what platelet count should platelets be transfused during postpartum hemorrhage?
Less than 75 x 10^9/l
What level should platelets be maintained at during ongoing postpartum hemorrhage to prevent bleeding?
Above 75 x 10^9/l
When should platelets be transfused during postpartum hemorrhage according to laboratory monitoring?
At exactly 75 x 10^9/l
What type of product should be used during elective transfusion in the antenatal period to ensure CMV seronegativity?
CMV-seronegative products
What should be infused if a woman with ongoing massive bleeding has not had coagulation results or platelet counts available after receiving 8 or more units of RBCs?
2 pools of cryoprecipitate and 1 pool of platelets
What fibrinogen level should be maintained during ongoing postpartum hemorrhage according to observational studies?
1.0–1.5 g/l
In cases of PPH, what fibrinogen level is associated with progression of bleeding, increased RBC requirements, and the need for invasive procedures?
Below 3 g/l
What did a double-blind RCT show regarding pre-emptive infusion of fibrinogen concentrate in women with moderate PPH?
No benefit
What is recommended to maintain during continuing PPH, even if PT/APTT are normal?
Fibrinogen level of at least 2 g/l
What should be used to replace fibrinogen loss during ongoing PPH?
Cryoprecipitate or fibrinogen concentrate
At what fibrinogen level should cryoprecipitate or fibrinogen concentrate be used to maintain adequate hemostasis during ongoing Postpartum Hemorrhage?
< 2 g/l
How should clinicians modify care plans in response to risk factors for Postpartum Hemorrhage?
By being aware of the risk factors and modifying care plans accordingly.
What is the recommended practice for women with known risk factors for PPH regarding the place of delivery?
Delivering in hospitals with a blood bank on site.
What is the role of antenatal anaemia management in reducing morbidity associated with Postpartum Hemorrhage?
It may reduce morbidity associated with PPH.
What is the benefit of offering prophylactic uterotonics in managing the third stage of labor?
They reduce the risk of Postpartum Hemorrhage.
What does the text suggest about the effectiveness of uterine massage in preventing Postpartum Hemorrhage?
It does not have any impact on PPH.
Why should women with known risk factors for Postpartum Hemorrhage be delivered in hospitals with a blood bank on site?
To ensure immediate access to blood products if needed.
Why should clinicians offer prophylactic uterotonics routinely in managing the third stage of labor according to the guideline?
To decrease the chances of Postpartum Hemorrhage occurring.
What should be done concerning uterine massage as a prophylaxis method for Postpartum Hemorrhage based on recent guidelines?
It should be avoided due to its ineffectiveness.
What type of blood should be maintained as a supply in all delivery units, especially those without a blood bank on site?
O-, RhD-negative blood
During postpartum hemorrhage, at what platelet count should platelets be transfused according to laboratory monitoring?
75 x 10^9/l
What plasma fibrinogen level should be maintained during ongoing postpartum hemorrhage?
2 g/l
When should antifibrinolytic drugs, such as tranexamic acid, be considered in the management of postpartum hemorrhage?
Only in clinical trials
What is the recommended action regarding the use of recombinant factor VIIa (rFVIIa) therapy in the management of major postpartum hemorrhage?
Not recommended unless part of a clinical trial
What should be infused if no haemostatic test results are available and bleeding is continuing after 4 units of red blood cells?
Fresh frozen plasma (FFP)
What is the recommended transfusion threshold for platelets during postpartum hemorrhage?
< 75 x 10^9/l
What is the primary role of the anaesthetist in the management of PPH?
Maintaining haemodynamic stability
What methods should be employed to arrest bleeding in PPH?
Pharmacological, mechanical, and surgical methods
What surgical treatment is recommended if pharmacological measures fail in controlling haemorrhage?
Intrauterine balloon tamponade
How should secondary PPH be managed?
Assessment of vaginal microbiology and antimicrobial therapy
What measures can be taken to ensure optimal management of PPH?
Multidisciplinary protocol in every unit
What is the most appropriate method of anaesthesia that the anaesthetist may need to determine and administer?
The most appropriate method for the situation
Which method should be considered first for most women with uterine atony as the cause of haemorrhage?
Intrauterine balloon tamponade
What should all staff involved in maternity care receive training on?
Management of obstetric emergencies
What type of training for Postpartum Hemorrhage (PPH) is recommended in the text?
Multiprofessional training with team rehearsals
When should cases of PPH with a blood loss greater than 1500 ml be reviewed?
Reviewed formally as a clinical incident
What is considered essential in accurate documentation of a delivery with PPH?
Involving the woman in debriefing
Why is debriefing recommended in the text regarding obstetric haemorrhage?
To offer an opportunity for discussion to the woman involved
What is emphasized as important when training for PPH management?
Team rehearsals and multiprofessional training
What does the text suggest regarding the timing of debriefing after obstetric haemorrhage?
Should be offered at a mutually convenient time to the woman involved
What is recommended for all cases of PPH involving a significant blood loss?
Formal clinical incident review
What type of training should include team rehearsals according to the text?
Multiprofessional training with team rehearsals
What is the recommended dose of oxytocin for prophylaxis in the third stage of labor for women without risk factors for PPH delivering vaginally?
10 iu by intramuscular injection
What should be used to encourage contraction of the uterus and decrease blood loss in women delivering by caesarean section according to the text?
Oxytocin (5 iu by slow intravenous injection)
What combination of medications might be superior to syntocinon alone for preventing PPH in women at increased risk?
Ergometrineoxytocin combination
In addition to oxytocin, what medication should clinicians consider using at caesarean section to reduce blood loss in women at increased risk of PPH?
Tranexamic acid
What should clinicians be aware of regarding the visual estimation of peripartum blood loss and the assessment of PPH?
It is inaccurate and clinical signs and symptoms should be included in the assessment
Who should be alerted when women present with minor PPH (blood loss 5001000 ml) without clinical shock?
The midwife in charge and first-line obstetric staff
What resuscitation measures are recommended for major PPH (blood loss greater than 1000 ml) and continuing bleeding or clinical shock?
A place patient flat, B keep patient warm, C transfuse blood as soon as possible, D administer corticosteroids
What is the recommended practice for women with known risk factors for PPH regarding the place of delivery?
Deliver in a hospital with a blood bank on site
What is the main limitation of routine coagulation tests like PT and APTT in acute and rapidly evolving bleeds?
They do not provide real-time bleeding assessment
What is the significance of PT/APTT greater than 1.5 times normal in managing postpartum hemorrhage?
It may indicate the need for early FFP administration
Why should FFP be considered early for conditions like placental abruption or amniotic fluid embolism?
To correct coagulopathy and ongoing bleeding
When should platelets be transfused during Postpartum Hemorrhage based on laboratory monitoring?
Based on laboratory findings of platelet count
What does NICE conclude about viscoelastometric point of care testing in managing postpartum hemorrhage?
It is superior to traditional coagulation tests
What role does fibrinogen assay play in the management of postpartum hemorrhage according to the text?
It guides the administration of cryoprecipitate
What triggers the need for volumes of FFP in excess of 15 ml/kg during ongoing hemorrhage for correction?
A drop in fibrinogen levels below a critical threshold
Why is debriefing recommended in the text regarding obstetric haemorrhage?
To review and learn from the management of the event
What is one of the key roles of the anaesthetist in the management of postpartum hemorrhage?
Determining and administering the appropriate method of anaesthesia
When uterine atony is suspected as a cause of postpartum hemorrhage, what sequence of measures should be taken?
Institute mechanical and pharmacological measures until bleeding stops
What is the recommended first-line 'surgical' intervention for most women with uterine atony causing hemorrhage?
Intrauterine balloon tamponade
What action should be taken if pharmacological measures fail to control postpartum hemorrhage?
Resort to immediate hysterectomy
'Secondary PPH' refers to postpartum hemorrhage occurring when?
24 hours to several days after delivery
What assessment should be performed in women presenting with secondary PPH?
Assessment of vaginal microbiology
'Optimal management of PPH' requires what according to the text?
'Multidisciplinary protocol' in every maternity unit
'Secondary PPH' may necessitate what kind of therapy?
'Antimicrobial therapy'
'Surgical evacuation of retained placental tissue' is recommended under what circumstances?
'In women with secondary PPH'
What is the recommended agent of choice for prophylaxis in the third stage of labor for women without risk factors for PPH delivering vaginally?
Oxytocin (10 iu by intramuscular injection)
In the absence of hypertension, what combination of medication is recommended for women at increased risk of haemorrhage to reduce the risk of minor PPH?
Ergometrine–oxytocin combination
When women are delivering by caesarean section, what dose of oxytocin should be used to encourage uterine contractions and decrease blood loss?
Oxytocin (5 iu by slow intravenous injection)
What route of administration is suggested for tranexamic acid in addition to oxytocin at caesarean section to reduce blood loss in women at increased risk of PPH?
Slow intravenous injection
What type of training is recommended for all staff involved in maternity care according to the text?
Multiprofessional training with team rehearsals
Under what circumstance should all cases of Postpartum Hemorrhage (PPH) be reviewed formally?
When they involve a blood loss greater than 1500 ml
Why is accurate documentation of a delivery with PPH considered essential?
For quality improvement and accountability purposes
When should women be offered an opportunity for debriefing after experiencing an obstetric hemorrhage?
At a mutually convenient time after the event
Which type of hemorrhage should lead to a formal clinical incident review according to the text?
Cases with a blood loss of greater than 1500 ml
What aspect of training for Postpartum Hemorrhage (PPH) should include team rehearsals?
Training for PPH with team rehearsals
Why should debriefing about an obstetric hemorrhage be offered to women according to the text?
To provide an opportunity to discuss the events surrounding the hemorrhage
What is the main purpose of maintaining a plasma fibrinogen level of greater than 2 g/l during ongoing Postpartum Hemorrhage?
To facilitate coagulopathy correction
When should clinicians consider using Cryoprecipitate according to the text?
When plasma fibrinogen level is low
What should be done before considering the use of Fresh Frozen Plasma (FFP) in conditions with suspected coagulopathy?
Ensure haemostatic test results are available
When should Platelets be transfused during Postpartum Hemorrhage?
When platelet count is below 150 x 10^9/l
What is recommended in cases where Prothrombin Time/Activated Partial Thromboplastin Time (PT/APTT) is more than 1.5 times normal and hemorrhage is ongoing?
Prepare for volumes of FFP in excess of 15 ml/kg
What is a reason provided in the text for ordering blood components as soon as a need for them is anticipated?
To avoid delays due to the need for thawing
Why is the routine use of recombinant factor VIIa (rFVIIa) not recommended in the management of major Postpartum Hemorrhage?
As it can lead to increased blood loss
What should be considered before initiating red cell transfusion according to the text?
Both clinical and haematological assessment
Test your knowledge on antenatal iron therapy for women with iron deficiency anemia who do not respond to oral iron. Explore the association between antenatal anemia and blood loss at delivery and postpartum based on RCOG Green-top Guideline No. 52.
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