9/26/2023 0 Comments Radia national![]() A rapid assessment of the entire genital tract for lacerations, hematomas, or signs of uterine rupture should be performed. Continuous assessment of vital signs and ongoing estimation of total blood loss is an important factor in ensuring safe care of the patient with PPH.Īn exam of the patient at the time of hemorrhage can help to identify the probable cause of bleeding focused on any specific risk factors the patient may have. In postpartum women, signs or symptoms of blood loss such as tachycardia and hypotension may be masked, so if these signs are present, there should be a concern for considerable blood volume loss (greater than 25% of total blood volume). Initial evaluation of the patient should include a rapid assessment of the patient’s status and risk factors. The California PPH toolkit states that those patients who are bleeding on presentation to labor and delivery, those with a history of PPH, hematocrit less than 30%, history of bleeding diathesis or coagulation deficit, morbidly adherent placenta, or with hypotension or tachycardia on presentation to labor and delivery should be considered high risk for PPH on admission. Genital tract trauma risk factors include operative vaginal delivery and precipitous delivery. Retained placenta and abnormal placentation are more common if an incomplete placenta is noted at delivery, a succenturiate lobe of the placenta is present, or if the patient has a history of previous uterine surgery. Coagulation abnormalities are more common in patients presenting with fetal death in utero, placental abruption, sepsis, disseminated intravascular coagulopathy (DIC), and in those with a history of an inherited coagulation defect. ![]() Risk factors that can lead to uterine inversion include excessive umbilical cord traction, short umbilical cord, and fundal implantation of the placenta. Risk factors for uterine atony include high maternal parity, chorioamnionitis, prolonged use of oxytocin, general anesthesia, and conditions that cause increased distention of the uterus such as multiple gestation, polyhydramnios, fetal macrosomia, and uterine fibroids. ![]() Risk factors for postpartum hemorrhage (PPH) are dependent on the etiology of the hemorrhage. Primary postpartum hemorrhage is bleeding that occurs in the first 24 hours after delivery, while secondary postpartum hemorrhage is characterized as bleeding that occurs 24 hours to 12 weeks postpartum. While this change was made with the knowledge that blood loss at the time of delivery is routinely underestimated, blood loss at the time of vaginal delivery greater than 500 mL should be considered abnormal with the potential need for intervention. Traditionally, postpartum hemorrhage (PPH) has been defined as greater than 500 mL estimated blood loss in a vaginal delivery or greater than 1000 mL estimated blood loss at the time of cesarean delivery. This was redefined in 2017 by the American College of Obstetrics and Gynecology as a cumulative blood loss greater than 1000 mL with signs and symptoms of hypovolemia within 24 hours of the birth process, regardless of the route of delivery. Obstetric hemorrhage is the most common and dangerous complication of childbirth. This activity reviews the causes of postpartum hemorrhage and highlights the role of the interprofessional team in the management of these patients. This was redefined by the American College of Obstetrics and Gynecology in 2017, and the current definition is cumulative blood loss greater than 1000 mL with signs and symptoms of hypovolemia within 24 hours of the birth process, regardless of the route of delivery. Traditionally, postpartum hemorrhage (PPH) has been defined as greater than 500 mL estimated blood loss associated with vaginal delivery or greater than 1000 mL estimated blood loss associated with cesarean delivery. Obstetric hemorrhage is the most common and dangerous complication of childbirth.
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