Labor Stage 3: Postpartum Hemorrhage

by Veronica Gillispie, MD, FACOG

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    So let's talk about Tone as we said this does account for most of our postpartum hemorrhages. We attempt to prevent atony by active management of the third stage of labor in each delivery. This means giving oxytocin after the delivery of the placenta. And for the reasons mentioned before, some patients are prone to atony despite the prophylactic treatment. You want to manage that with uterine massage. And this is how it's performed as you can see here. One thing to know is important to first empty the bladder to make sure your uterine massage is more effective. Next you want to give additional oxytocin. And if you still have an atony you want to consider using other uterotonic agents. Let's go through those in a little detail. So our first uterotonic agent to talk about is Methlyergonivine. So this is methrogen. Now it is a very good medication to help contract the uterus. But it is contraindicated in hypertension and can increase the blood pressure . Next is PGF2 Alpha or Hemabay. This is also a great uterotonic agent but it is contraindicated in patients that have asthma. And then third is misoprostol. This can be given vaginally or it can be given rectally or orally. Vaginally is less effective because the patient is bleeding and so usually they can't absorb the misoprostol as effectively. So you would want to consider your oral or rectal route. And there are no real indications to give a misoprostol. So what's our direct therapy for retained products of conception. That's either be going to manual exploration to remove the placenta or D&C. You should be suspicious for retained products of conception. If the placenta is not removed intact. Remember when we deliver our placenta we give gentle downward traction on the...

    About the Lecture

    The lecture Labor Stage 3: Postpartum Hemorrhage by Veronica Gillispie, MD, FACOG is from the course Intrapartum Care. It contains the following chapters:

    • Postpartum Hemorrhage
    • Management of Postpartum Hemorrhage

    Included Quiz Questions

    1. Uterine atony
    2. Retained products of conception
    3. Cervical lacerations
    4. Perineum tears
    5. Thrombin disorders
    1. Half a liter
    2. 1 Liter
    3. 800 milliliters
    4. 250 milliliters
    5. 750 milliliters
    1. 1000 ml
    2. 500 ml
    3. 1500 ml
    4. 2000 ml
    5. 800 ml
    1. ... uterine atony.
    2. ...endometritis.
    3. ...retained products of conception.
    4. ,,,subinvolution of the uterus.
    5. ...coagulation disorders.
    1. Chorioamnionitis
    2. Oligohydramnios
    3. Primiparity
    4. Succenturiate lobes of the placenta
    5. Placenta increta
    1. Assure she has two large bore IVs and administer IV fluids
    2. Type and screen and wait for matched blood for resuscitation
    3. Obtain coagulations labs to rule out bleeding disorder
    4. Ask the nurses to quantify the blood loss to see if it is greater than 1000 cc in addition to intraoperative blood loss
    5. Check a complete blood count and examine results to evaluate if the patient needs blood products administered

    Author of lecture Labor Stage 3: Postpartum Hemorrhage

     Veronica Gillispie, MD, FACOG

    Veronica Gillispie, MD, FACOG

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