Massive Obstetric Hemorrhage - Health Research at Fernandez ...

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• Call for help Communication Teamwork • Senior obstetrician / anesthetist • Alert portering service / blood bank • Allocate roles • Practice fire drills
Goals • Early institution of massive obstetric drill • Rapid access to circulation • Efficient team working • Management decision making
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Massive Obstetric Hemorrhage Manage
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HOSPITAL Dedicated wholly to Women
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Labour Epidural Analgesia Dedicated
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Massive Obstetric Hemorrhage “Obs
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Maternal mortality in India: WHO st
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• 585000 maternal deaths per year
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Obstetrical Hemorrhage Blood loss a
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The position of a woman in any civi
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Major Obstetric Haemorrhage As an A
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Admission Conscious, incoherent D
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Simultaneous Team Work History Taki
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Emergency Treatment IM Carboprost
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Lab Results Haemoglobin Undetectabl
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SURVIVING BLOOD LOSS
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Categorization of Acute Hemorrhage
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Remember… Blood Loss % Loss Respo
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Resuscitation • 2 large bore IV c
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Targets of Resuscitation Mental sta
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Platelet depletion Factor depletion
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Obstetric Hemorrhage Pathophysiolog
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Fluid Choices Fluid Type Comments N
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Very important to maintain adequate
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Severe Ongoing Hemorrhage Worsening
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Aim to Maintain • Adequate intrav
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The Trigger… Blood & Blood Compon
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Diagnosis of Coagulopathy Activatio
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Packed Cell Transfusion • PRB‟c
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Intra - Op Findings • Uterus enla
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Post Operative - Findings • Oozin
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Post Op Period - Stormy Prevent MOD
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Post Op Period Weaned off ventilato
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Incidence PPH : 4 - 6 % of deliveri
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Massage Uterus Protocol Soft Atonic
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When Oxytocics Fail Medical managem
Page 72 and 73: Choice of Procedure • Age & Parit
Page 74 and 75: Uterine Tamponade • Gauge packing
Page 76 and 77: Sengstaken Tube Condom Tamponade
Page 78 and 79: B Lynch 2 1
Page 80 and 81: Hayman‟s Sutures
Page 82 and 83: De-vascularization Uterine Ovarian
Page 84 and 85: Uterine / Ovarian Ligation
Page 86 and 87: 32 years, 2 nd Pregnancy • G 2 P
Page 88 and 89: 24 weeks, 4 am • Pain abdomen + b
Page 90 and 91: Blood loss ?
Page 92 and 93: Resuscitation Ongoing • Internal
Page 94 and 95: II Post Op Day • Re-laparotomy (
Page 96 and 97: Recombinant Factor VIIa • Life sa
Page 98 and 99: FVIIa boosts thrombin generation on
Page 100 and 101: Case 5 : Placenta Percreta with Mas
Page 102 and 103: Radiological Interventions: Adheran
Page 104: INFLATED BALLOON IN LEFT INTERNAL I
Page 110 and 111: Retaining Placenta: Our experience
Page 112 and 113: What Can be Done ? • Recognition
Page 114 and 115: Complications of Massive Blood Tran
Page 116 and 117: Recognition of Coagulopathy Anticip
Page 120 and 121: Protocol Prevention • Active mana
Page 124: Early Warning Obstetric Chart
Page 127 and 128: 5000 4000 3000 2000 1000 0 Number o
Page 129 and 130: The Practice Point Active communica
Page 131: Life is no brief candle to me. It i
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