Module 6.1: Postpartum Hemorrhage

Early hemorrhage

Excessive bleeding for the first 24 hours postpartum and has the greatest danger

Late hemorrhage

Excessive bleeding after 24 hours to 6 weeks postpartum

Uterine atony

Refers to the failure of the uterus to contract

Trauma, tone, tissue, thrombin

Four T’s in postpartum hemorrhage

5mL

How many mL of blood loss is there in a 5g saturated pad?

To prevent pooling

Why is it important to turn the patient to the side when checking for blood loss?

Drain bladder and fundal massage

What is the primary management for uterine atony?

Supine with knees flexed

Position during bimanual compression

Uterine prolapse

What could result with aggressive bimanual compression?

Sonogram to detect retained placental fragments

What is the next step if fundal massage and uterotonics do not work?

Scant/odorous discharge and increased temperature

What are the two early signs of infection?

Lithotomy

What position during birth could result in lacerations?

Cervical laceration

What type of laceration is characterized by bright red, arterial bleeding and is difficult to suture due to intense bleeding that obstructs visualization?

Vaginal lacerations

What type of laceration is easier to locate but difficult to suture due to its friable tissue?

Regional

What type of anesthesia can be given to patients with cervical lacerations?

24-48 hours

After how many hours should vaginal packing be removed?

Ultrasound and blood serum sample for HcG

What diagnostic tests are used to detect retained placental fragments?

6-10 days

How many days postpartum can small retained placental fragments be detected?

Disseminated intravascular coagulation

It refers to a deficiency in clotting ability, therefore there is a development of small blood clots in the bloodstream.

Pelvic ultrasound and speculum exam

What are the diagnostic means to detect DIC?

Heparin

What drug is used in DIC to slow down clotting?