Postpartum hemorrhage: Difference between revisions

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###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)
###Bakri balloon placement (large Foley cathether if Bakri not available; fill with NS until tamponaded)
###Bakri balloon placement (or substitute with large or multiple Foleys)
##[[Uterine inversion]]:
##[[Uterine inversion]]:
###Manually replace placenta:
###Manually replace placenta:

Revision as of 19:02, 18 February 2015

Background

Causes

  1. Uterine atony
    1. Retained placental fragments
  2. Lower genital tract lacerations
  3. Uterine rupture
  4. Uterine inversion
  5. Hereditary coagulopathy

Differential Diagnosis

3rd Trimester/Postpartum Emergencies

Management

  1. Fluid resuscitation
  2. Consider Blood Products for Hemodynamic Instability
  3. Treat underlying cause:
    1. Uterine atony:
      1. Bimanual Massage
      2. Oxytocin (Pitocin) 10mg IM or slow IV push (rapid administration may cause hypotension)
      3. Misoprostol (Cytotec) 600mcg SL
      4. Methylergonovine (Methergine) 0.2mg IM (contraindicated in pts with HTN or Preeclampsia)
      5. Carboprost (Hemabate) 250mcg IV (avoid in pts with HTN or asthma)
      6. Bakri balloon placement (or substitute with large or multiple Foleys)
    2. Uterine inversion:
      1. Manually replace placenta:
        1. Place hand inside the vagina and push the fundus cephalad along long axis of vagina

Source

Tintinalli

See Also

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