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Postpartum hemorrhage

This is a brief video on postpartum hemorrhage, or excess bleeding following childbirth. I created this presentation with Google Slides. Images were created or taken from Wikimedia Commons I created this video with the YouTube Video Editor. ADDITIONAL TAGS Postpartum hemorrhage Overview Causes Medications Other management By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See "Book" section below)Bartleby.com: Gray's Anatomy, Plate 1170, Public Domain, https://commons.wikimedia.org/w/index... Excess bleeding following childbirth Defined as, in 24 hours after delivery: Over 500 ml blood loss after vaginal delivery Over 1000 ml blood loss after c-section Signs and symptoms include faintness/lightheadedness with standing/straining, increased heart rates and respiratory rates Severe blood loss: low BP, feeling cold, loss of consciousness (hypovolemia and shock) Risk factors: infection (chorioamnionitis), prolonged labor, multiple gestations Overview Overview Causes Medications Other management Tone: Uterine atony (inability to contract), sign: boggy uterus Retained placental tissue, infection can contribute to atony Prolonged labor contributes to atony (uterus is tired) Inverted uterus, sign: absent uterus Trauma: injury to uterus, cervix, vagina, or perineum, both before and during delivery (often precipitous deliveries) Sign: lacerations Perineal injury: 1st degree is mucosa only, 2nd involves perineal body, 3rd involves rectal sphincter, 4th involves rectal mucosa Tissue: retained tissue from placenta or fetus Placenta burrows deeply into uterus (accreta increta percreta); might have accessory lobes, placental tear Dx with ultrasound or placental inspection (blood vessels at placental edge) Sign: firm uterus Thrombin: failure to clot blood, such as from coagulation disorders, DIC Causes - four Ts Overview Causes Medications Other management Dehydration: two large bore IVs, fluids Oxytocin - contracts uterus, prolongs contractions (for uterine atony) Consider other management (next slide) Misoprostol, carboprost - prostaglandin analogs Side effects: fever and shivering Methylergonovine - ergot drug, which vasoconstricts decreasing blood supply to bleeding organ Oxytocin + ergometrine in combination drug Syntometrine Medications Overview Causes Medications Other management Uterine massage Surgery and/or sutures to repair lacerations Hysterectomy in severe cases Uterine artery embolization with help of interventional radiology or ligation with obstetrics D&C to remove retained products of conception Other management Overview Causes Medications Other management By Valerie Henry - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index... and ***48357595