Obstetric Haemorrhage

education haemorrhage obstetrics anaesthesia patient safety safety Oct 02, 2023

“We gave 27 units of blood!” ๐Ÿฉธ ๐Ÿฉธ

When obstetric patients bleed, they bleed quickly!

Did you know the uterus receives 25% of cardiac output at term? ๐Ÿ˜ฎ

Major obstetric haemorrhage is relatively common, so your team needs to be trained at recognising and managing it ๐Ÿซก

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! โœ… ๐Ÿค

There are many causes, so let’s break it down:

1๏ธโƒฃ Antepartum (APH): 24 weeks – term
๐Ÿ‘‰๐Ÿฝ Placenta praevia & abruption
๐Ÿ‘‰๐Ÿฝ Uterine rupture
๐Ÿ‘‰๐Ÿฝ Bleeding from cervix or vagina

2๏ธโƒฃ Postpartum (PPH): after delivery (The 4 T’s)
๐Ÿ‘‰๐Ÿฝ Tone – uterine tone (80%)
๐Ÿ‘‰๐Ÿฝ Trauma – laceration, haematoma, inversion, rupture
๐Ÿ‘‰๐Ÿฝ Tissue – retained tissue/invasive placenta
๐Ÿ‘‰๐Ÿฝ 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๏ธโƒฃ ABC: Be ready to convert to GA, place an arterial line and give blood products through a large bore IVC.
2๏ธโƒฃ Address the 4 Ts:
๐Ÿ‘‰๐ŸปTone: oxytocin, ergometrine, carboprost
๐Ÿ‘‰๐ŸปTrauma & Tissue: involve the obstetric team (& sometimes the interventional radiologist).
๐Ÿ‘‰๐ŸปThrombin: monitor coagulation and replace clotting factors

Now you are ready to manage massive obstetric haemorrhage! ๐Ÿ™Œ

Build knowledge โœ…
Improve safety โœ…

Ref: https://www.bjaed.org/action/showPdf?pii=S2058-5349%2817%2930145-2

 

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