Obstetric Haemorrhage
Oct 02, 2023
“We gave 27 units of blood!” ๐ฉธ ๐ฉธ
When obstetric patients bleed, they bleed quickly!
Did you know the uterus receives 25% of cardiac output at term? ๐ฎ
Major obstetric haemorrhage is relatively common, so your team needs to be trained at recognising and managing it ๐ซก
Up to 1L blood loss is relatively common at delivery, and there is some contention over the exact definition of massive obstetric bleeding.
For simplicity, let’s say that over 1L of blood loss during delivery needs a prompt and coordinated team approach! โ
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There are many causes, so let’s break it down:
1๏ธโฃ Antepartum (APH): 24 weeks – term
๐๐ฝ Placenta praevia & abruption
๐๐ฝ Uterine rupture
๐๐ฝ Bleeding from cervix or vagina
2๏ธโฃ Postpartum (PPH): after delivery (The 4 T’s)
๐๐ฝ Tone – uterine tone (80%)
๐๐ฝ Trauma – laceration, haematoma, inversion, rupture
๐๐ฝ Tissue – retained tissue/invasive placenta
๐๐ฝ Thrombin – coagulopathy
To safely manage PPH, you need to communicate well and escalate if you don’t see a response. Call for help early, and remain suspicious about ongoing bleeding.
1๏ธโฃ ABC: Be ready to convert to GA, place an arterial line and give blood products through a large bore IVC.
2๏ธโฃ Address the 4 Ts:
๐๐ปTone: oxytocin, ergometrine, carboprost
๐๐ปTrauma & Tissue: involve the obstetric team (& sometimes the interventional radiologist).
๐๐ปThrombin: monitor coagulation and replace clotting factors
Now you are ready to manage massive obstetric haemorrhage! ๐
Build knowledge โ
Improve safety โ
Ref: https://www.bjaed.org/action/showPdf?pii=S2058-5349%2817%2930145-2
