Postpartum Hemorrhage - Differential Diagnosis and ...
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Postpartum Hemorrhage - Differential Diagnosis and Management 

Uterine Atony (80%) - Most PPH Will respond to first line atony treatrrEnts

 • Uterine massage

 • Oxytocin 40 IU in 1 liter IVNS

 • Drain bladder with Foley

 • If continued bleeding:

     - Misoprostol (Cytotec) 400 mcg sublingually or 1 g per rectum

     - TXA 1 g over 10 minutes, may repeat xl

 • If continued bleeding:

     - Methylergonovine (Methergine) 0.2 mg IM (contraindicated in hypertension)

     - Carboprost (Hemabate) 250 mcg IM q 15 min prn (contraindicated in asthma)

Retained products of conception - Does placenta deliver easily and look complete?

    1. Maternal analgesia

    2. Using external abdominal hand, push uterus inferiorly (toward intravaginal examining hand)

    3. Sweep inside of uterus with hand to gather POC

Trauma to birth canal - inspect vagina and cervix

 • Direct pressure

 • Laceration repair with suture (2-0 Vicryl)

 • Inject with epinephrine prn

DIC/occult coagulopathy

 • CBC, fibrinogen, PT/PTT

 • Treat with cryoprecipitate prn

 • TEG if available

Maneuvers for life-threatening bleeding unresponsive to usual treatment:

 • Intrauterine balloon tamponade with Bakri Balloon or equivalent

 • Uterine packing with gauze/procoagulants

 • External aortic compression (using ultrasound if available)

 • REBOA / Laparotomy / Cesarean



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Contributed by

Dr. Gerald Diaz
@GeraldMD
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG:  https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
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