产科出血的新进展高原—培训课件.ppt

OB Hemorrhage Risk Factor, low No previous uterine incision Singleton pregnancy Less than five previous vaginal births No known bleeding disorder No history of PPH OB Hemorrhage Risk Factor, medium Prior cesarean birth(s) or uterine surgery Multiple gestation Four or more previous vaginal births Chorioamnionitis History of previous PPH Large uterine fibroids Estimated fetal weight greater than 4 kg Morbid obesity (BMI>35) OB Hemorrhage Risk Factor, high Placenta previa, low lying placenta Suspected placenta accreta or percreta Hematocrit <30 and other risk factors Platelets <100,000 Active bleeding (greater than show) on admit Known coagulopathy STAGE 0: All Births: Prevention & Recognition of OB Hemorrhage Active management of 3rd stage: 10-20 units oxytocin/1000ml solution titrate infusion rate to uterine tone; or 10 units IM; do not give oxytocin as IV push Vigorous fundal massage for at least 15 seconds Ongoing QBL evaluation: using formal methods, such as graduated containers, weight of blood soaked materials (1gm=1ml) STAGE 1: QBL > 500ml Vag or 1000ml CS or VS unstable with continued bleeding Activate OB hemorrhage protocol and checklist Notify obstetrician, charge nurse and anesthesiologist Establish IV access, at least 18 gauge, increase IV fluid rate, and increase oxytocin rate Administer methergine per protocol Vital signs, O2 sat(>95%) & level of consciousness STAGE 1: con’t Empty bladder, monitor urinary output Type and Crossmatch for 2 units PRBCs Keep patient warm Consider potential etiology: uterine atony, trauma/laceration, retained placenta, amniotic fluid embolism, uterine inversion, coagulopathy, placenta accreta and uterine rupture Once stabilized: modified postpartum management with increased surveillance An Update on Obstetric Hemorrhage STAGE 2: QBL 1000-1500ml with continued bleeding Activate response team, notify perinatologist, 2ndOB, 2ndanesthesiologist Notify blood bank, assign single person to communicate with blood bank Addit