Postpartum hemorrhage: Difference between revisions
m (Rossdonaldson1 moved page Post-Partum Hemorrhage to Postpartum hemorrhage) |
No edit summary |
||
| Line 1: | Line 1: | ||
==Causes== | ==Background== | ||
#Uterine atony | ===Causes=== | ||
#[[Uterine atony]] | |||
##Retained placental fragments | ##Retained placental fragments | ||
#Lower genital tract lacerations | #Lower genital tract lacerations | ||
#Uterine rupture | #[[Uterine rupture]] | ||
#Uterine inversion | #Uterine inversion | ||
#Hereditary coagulopathy | #Hereditary [[coagulopathy]] | ||
==Differential Diagnosis== | |||
{{Postpartum emergencies DDX}} | |||
==Management== | ==Management== | ||
#Fluid resuscitation | #[[Fluid resuscitation]] | ||
#Consider Blood Products for Hemodynamic Instability | #Consider Blood Products for Hemodynamic Instability | ||
#Treat underlying cause: | #Treat underlying cause: | ||
##Uterine atony: | ##[[Uterine atony]]: | ||
###Bimanual Massage | ###Bimanual Massage | ||
###Oxytocin (Pitocin) 10mg IM or slow IV push (rapid administration may cause hypotension) | ###Oxytocin (Pitocin) 10mg IM or slow IV push (rapid administration may cause hypotension) | ||
| Line 17: | Line 21: | ||
###Methylergonovine (Methergine) 0.2mg IM (contraindicated in pts with HTN or Preeclampsia) | ###Methylergonovine (Methergine) 0.2mg IM (contraindicated in pts with HTN or Preeclampsia) | ||
###Carboprost (Hemabate) 250mcg IV (avoid in pts with HTN or asthma) | ###Carboprost (Hemabate) 250mcg IV (avoid in pts with HTN or asthma) | ||
##Uterine inversion: | ##[[Uterine inversion]]: | ||
###Manually replace placenta: | ###Manually replace placenta: | ||
####Place hand inside the vagina and push the fundus cephalad along long axis of vagina | ####Place hand inside the vagina and push the fundus cephalad along long axis of vagina | ||
==Source== | ==Source== | ||
Revision as of 17:14, 10 January 2015
Background
Causes
- Uterine atony
- Retained placental fragments
- Lower genital tract lacerations
- Uterine rupture
- Uterine inversion
- Hereditary coagulopathy
Differential Diagnosis
3rd Trimester/Postpartum Emergencies
- Acute fatty liver of pregnancy
- Amniotic fluid embolus
- Chorioamnionitis
- Eclampsia
- HELLP syndrome
- Mastitis
- Peripartum cardiomyopathy
- Postpartum endometritis (postpartum PID)
- Postpartum headache
- Postpartum hemorrhage
- Preeclampsia
- Resuscitative hysterotomy
- Retained products of conception
- Septic abortion
- Uterine rupture
Management
- Fluid resuscitation
- Consider Blood Products for Hemodynamic Instability
- Treat underlying cause:
- Uterine atony:
- Bimanual Massage
- Oxytocin (Pitocin) 10mg IM or slow IV push (rapid administration may cause hypotension)
- Misoprostol (Cytotec) 600mcg SL
- Methylergonovine (Methergine) 0.2mg IM (contraindicated in pts with HTN or Preeclampsia)
- Carboprost (Hemabate) 250mcg IV (avoid in pts with HTN or asthma)
- Uterine inversion:
- Manually replace placenta:
- Place hand inside the vagina and push the fundus cephalad along long axis of vagina
- Manually replace placenta:
- Uterine atony:
Source
Tintinalli