Postpartum Hemorrhage Management Quiz

Placental Malfunction

• Antiphospholipid syndrome (APAS) is an autoimmune response where the body attacks the placenta, putting the pregnancy at risk.
• Risk factors for APAS include:
  • Cigarette smoking
  • Low socioeconomic condition
  • Lack of prenatal check-ups
  • Previous history of miscarriage
  • Infections such as Toxoplasmosis, HIV, Hepatitis B, and Syphilis
• Signs and symptoms of APAS include:
  • Positive pregnancy test
  • Increased HCG levels
  • Excessive vomiting leading to metabolic alkalosis
  • Abdominal enlargement
  • Vaginal bleeding with vesicles
  • Ultrasound showing no fetal heart tone or outline

Types of Abortion

• Spontaneous abortion: naturally occurring
• Induced abortion: intentionally done to save the life of the mother
• Threatened abortion: uterine cramping and vaginal bleeding with a closed cervix
• Inevitable abortion: uterine cramping with an open cervix
• Complete abortion: all products expelled with a closed cervix
• Incomplete abortion: not all products expelled with an open cervix
• Habitual abortion: multiple consecutive spontaneous abortions
• Missed abortion: fetus dies in the uterus with a closed cervix

Causes of Abortion

• Uterine anomalies
• Multiparity (more than 4 pregnancies)
• Twins (dizygotic or fraternal)
• Antiphospholipid syndrome (APAS)

Incompetent Cervix

• Premature dilation of the cervix
• Cause: trauma to the cervix
• Effect: habitual abortion
• Signs and symptoms:
  • Vaginal bleeding
  • Small for gestational age fetus
  • Hemorrhage
• Management:
  • Bed rest
  • Avoid heavy lifting
  • Cerclage (suturing of the cervix)

Placenta Previa

• Low implantation of the placenta
• Types:
  • Low-lying
  • Partial
• Management:
  • Bed rest
  • Avoid heavy lifting
  • Terbutaline (tocolytic) to stop uterine contraction

Cord Prolapse

• Decreased fetal heart tone (FHT) with variable deceleration
• Management:
  • Position the mother into a knee-chest, face down position
  • Continue to digitally relieve the pressure on the cord
  • Avoid handling the cord to reduce vasospasm
  • Increase IV rate and administer oxygen by face mask
  • Discontinue oxytocin infusion

Post-Partum

• Uterus:
  • Palpate fundus in the umbilicus on the day of delivery
  • Decrease by 1 cm per day
• Post-partum depression (PPD):
  • Sudden crying
  • Severe sadness lasting for 6 months
  • Needs support and antidepressant drugs

Post-Partum Hemorrhage

• Blood loss of more than 500 ml (NSD) or 1000 ml (CS)
• Causes:
  • PIH (Pregnancy Induced Hypertension)
  • Uterine atony
  • Laceration
  • Blood disorder
  • Retained placental fragments

Pregnancy Induced Hypertension (PIH)

• Cause: unknown, but related to pregnancy and placenta
• Effects:
  • Vasospasm and vasoconstriction
  • Decreased blood supply to the kidney
  • Proteinuria
  • Edema
• Types:
  • Gestational hypertension
  • Pre-eclampsia
  • Eclampsia

Management of PIH

• Mild preeclampsia/gestational hypertension:
  • Bed rest
  • Adequate protein intake
  • Observation and report of signs and symptoms of severe preeclampsia
• Severe preeclampsia:
  • Provide a quiet environment
  • Decrease stimuli
  • Uterine atony management

Additional Information

• Umbilical cord prolapse: when the umbilical cord exits through the open cervix into the vagina before the baby moves into the birth canal
• Cardiac disease during pregnancy:
  • Congenital heart disease is the most common heart condition during pregnancy
  • Risk factors: premature birth, abnormal heart rhythm, and heart failure