Obstetric Hemorrhage

Author: Carol Harvey, MS, RNC-OB, C-EFM, Gary Dildy, M.D.
Affiliation:
Publisher: AWHONN
Publication Date: 2012
ISBN 10: 0015607151
ISBN 13: 9780015607159
eISBN: 9780015607319
Edition: 1st

Description:

Obstetric hemorrhage is a major contributor to maternal morbidity. All obstetric clinicians should be prepared to identify and appropriately respond to this potentially life-threatening complication of pregnancy. This monograph provides essential knowledge and tools needed to promote more positive outcomes and provide safer patient care. The inherent need for collaboration is reinforced and clinical case excerpts are presented to support the application of concepts to practice. Strategies and ideas for preparation through simulation are also presented.

Table of Contents

Front Matter

  • ABOUT
  • About AWHONN
  • preface
  • preface

Introduction

    Physiology of Pregnancy and Postpartum Blood Loss

      Etiologies of Obstetric Hemorrhage

        Patients at Risk for Obstetric Hemorrhage

          Assessment of Blood Loss

            Medical (Non-Surgical) and Surgical Management of Postpartum Hemorrhage

              Pharmacologic Therapy for Uterine Atony

                General Management of Obstetric Hemorrhage

                • UTERINE PACKING AND INTRAUTERINE TAMPONADE BALLOONS
                • INTERVENTIONAL RADIOLOGY
                • HYSTERECTOMY
                • SHOCK

                Coagulopathy and Obstetric Hemorrhage

                  Critical Management Principles: “Bloody Vicious Cycle”

                    Volume Replacement Therapy

                      Blood Component Therapy

                      • HEMODYNAMICALLY STABLE PATIENTS WITHOUT COAGULOPATHY
                      • HEMODYNAMICALLY UNSTABLE PATIENTS WITH COAGULOPATHY

                      Blood Components

                      • RED BLOOD CELLS
                      • FRESH FROZEN PLASMA (FFP)
                      • PLATELETS
                      • CRYOPRECIPITATE ANTIHEMOLYTIC FACTOR (AHF, CRYOPRECIPITATE)
                      • COMPLICATIONS OF BLOOD TRANSFUSION

                      Other Products Used in Hemorrhage

                      • DESMOPRESSIN (DDAVP)
                      • RECOMBINANT ACTIVATED FACTOR VII (rFVIIa)
                      • ANTIFIBRINOLYTICS

                      Cell Saver Use During Cesarean Section

                        Jehovah’s Witness Patients and Cell Saver Use

                          Complications of Massive Hemorrhage

                          • REPERFUSION INJURY
                          • RH SENSITIZATION

                          Preparing for Obstetric Hemorrhage

                            Collaborative Management of Massive Postpartum Hemorrhage and Patient Safety

                              Summary

                                References

                                APPENDIX A: Acronyms in Document

                                APPENDIX B: Admission Risk Screening for Postpartum Hemorrhage and Blood Bank Request*

                                APPENDIX C: Supplemental Physician/Provider Orders for Prevention and Treatment of Postpartum Hemorrhage

                                APPENDIX D: Guideline for the Transfer of an Obstetric (OB) Patient to an Operating Room*

                                APPENDIX E: Comparison of Uterine Tamponade Balloon Catheters for the Treatment of Postpartum Bleeding

                                APPENDIX F: Collaborative Guideline and Procedure for Placement of an Intrauterine Balloon Tamponade Catheter

                                APPENDIX G: Self-Assessment of Clinical Site for Readiness to Provide Massive Obstetric Hemorrhage Resuscitation*

                                APPENDIX H: Recommendations for Additional Resources for PPH Managed in a General Surgery OR*

                                APPENDIX I: Creating an Effective Obstetric Hemorrhage Team

                                APPENDIX J: Collaborative Guideline for Massive Transfusion (MTG)

                                APPENDIX K: Algorithm for Management of Postpartum Hemorrhage

                                APPENDIX L: Where to Find Simulation Scenarios for Obstetric Hemorrhage on the Internet