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OB Hemorrhage


Most common cause of postpartum hemorrhage Uterine atony (unable to contract and control bleeding)
extravasation of blood into the myometrium = Couvelaire uterus
Placenta previa sx Spotting in 1st & 2nd trimesters. Sudden painless vaginal bleeding in 3rd. Soft, nontender uterus.
Abruptio placenta RF HTN; trauma; folate deficiency; smoking; cocaine; PPROM; chorioamnionitis; rapid decompression of the uterus; thrombophilia; older mom; multiple gestation.
Causes of postpartum hemorrhage uterine rupture/ inversion; birth trauma; retained placenta; uterine atony; DIC; von W dz
Uterine inversion associated with: uterine atony, fundal placenta, first baby; not necessarily with cord traction
Uterine inversion sx shock out of proportion to blood loss
Uterine inversion tx Replacement; relaxing agent; laparotomy?
Uterine atony RF Chorioamnionitis; over-distended uterus; long labor; oxytocin in labor; MgSO4; genl anesthesia; multiparity; previous postpartum hemorrhage
Uterine atony tx Oxytocin; PG F2 alpha (Hemabate); misoprostol; methergine; bimanual compression
Types of placental abruption Grade 1 (mild, slight bleeding). Grade 2 (moderate to partial). Grade 3 (large or complete): concealed (blood is retained between detached placenta & uterus)
risks associated with PROM & PPROM Infection (chorioamnionitis & endometritis); cord prolapse
Placental tissue in the lower uterine segment over, or adjacent to, the cervical os = Placenta previa (results in coverage of cervix, ahead of presenting fetal part)
In placenta previa, bleeding results from: separation of placenta from lower uterine segment and cervix
Placenta previa risk factors Prior uterine surgery, C-section, D&C, D&E. Older pt. Endometrial vascularity abnormality. Delayed ovulation. Multiparity. Smoking.
Dx of placenta previa should be done by: Ultrasound. NOT BY PELVIC EXAM
Grade 3 placental abruption should be considered: life threatening to mother and fetus
Placental abruption pathology Bleeding into decidua basalis -> separation -> decidua splits and placenta is sheared off -> extravasation into myometrium
Bleeding >500 mL with vaginal delivery or >1000 mL with C-section postpartum hemorrhage (early <24h post; late >24h post, up to 6-12 weeks post partum)
Created by: Adam Barnard Adam Barnard