Questions and Answers
The most frequent cause of obstetrical hemorrhage is _____ atony.
uterine
Active management of the third stage of labor includes giving _____ right after the delivery of the baby.
oxytocin
Risk factors for obstetrical hemorrhage include previous history and _____ delivery.
preterm
If heavy bleeding persists after delivery, manual _____ removal is indicated.
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_____ control/cord traction is a strategy used in the management of the third stage of labor.
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Giving of oxytocin as an undiluted bolus dose can lead to serious hypotension or _____.
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Volume resuscitation is critical after interventions like breech _____ or cesarean.
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Retained placenta can occur if it is not delivered within _____ minutes after the infant.
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Antibiotics such as _____ and cefazolin may be given during management of hemorrhage.
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Coagulation changes during pregnancy can influence both antepartum and _____ hemorrhage.
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Study Notes
Obstetrical Hemorrhage Overview
- Obstetrical hemorrhage is categorized into antepartum and postpartum hemorrhages.
- Causes of hemorrhage are summarized as the 4 Ts: Tone, Tissue, Trauma, and Thrombin.
General Considerations
- Normal hemostasis involves a significant blood flow through the intervillous space, approximately 600 mL/min near term.
- Full coagulation is not necessary for postpartum hemostasis unless there are lacerations.
- Myometrial contraction is crucial for hemostasis post-placental separation by compressing vessels at the implantation site.
Postpartum Hemorrhage
- Defined as cumulative blood loss exceeding 1000 mL with signs of hypovolemia.
- Vigilance is required as pulse and blood pressure may not show significant changes until substantial blood loss occurs.
Blood Loss Estimation
- Blood loss should be estimated based on postpartum hematocrit levels; a lower hematocrit than at admission indicates potential blood loss.
- For each 3% decrease in hematocrit, an additional 500 mL of blood loss is estimated.
Uterine Atony
- Most common cause of postpartum hemorrhage.
- Management includes active interventions during the third stage of labor and manual removal of the placenta if bleeding persists.
- Adequate antibiotic coverage is essential, commonly with ampicillin and cefazolin.
- Intravenous oxytocin (20 U in 1000 mL) is effective for uterine atony but should never be given as an undiluted bolus.
Retained Placenta
- Retained placenta occurs if the placenta is not delivered within 30 minutes post-delivery.
- Active management techniques include IM oxytocin administration and cord traction with uterine massage.
Risk Factors for Hemorrhage
- Prior history of obstetrical hemorrhage or complications increases the risk.
- Conditions such as preterm labor, use of ergometrine, and uterine abnormalities significantly contribute to hemorrhage risk.
Antepartum Hemorrhage
- Defined as vaginal bleeding occurring after the 24th week of pregnancy before childbirth.
- Conditions include placental abruption, placenta previa, and vasa previa.
Obstetrical Coagulopathies
- Pregnancy-induced coagulation changes may aggravate bleeding tendencies and should be monitored.
Management of Hemorrhage
- Volume resuscitation is critical, necessitating two large-bore IV access points.
- Thorough inspection of the cervix and vagina is vital for potential injuries and retained products.
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Description
This quiz covers the key aspects of obstetrical hemorrhage, including its classifications and causes. Focus is given to antepartum and postpartum hemorrhage, along with crucial considerations for hemostasis and blood loss estimation. Test your understanding of the 4 Ts and the importance of myometrial contraction.
