Massive Obstetric Hemorrhage - Health Research at Fernandez ...

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Aim to Maintain • Adequate intravascular volume • Oxygen carrying capacity • Clotting function • Electrolyte balance • Prevention of Hypocalcemia • Normothermia
• GETA – FiO 2: 1 Anaesthetic Goals • If started under CNB – Rapid sequence GETA • Wide bore Venous Access: 14g x 2, ABP, CVP • Avoid Volatile Inhalational agents / N 2O • Low dose ketamine / Fentanyl / Midazolam for knocking down awareness • Active warming devices – V. Imp • ABG, K + , Ca ++ , Coag. Profile – Serially • Rapid Infusion Devices
Page 1 and 2: Massive Obstetric Hemorrhage Manage
Page 3 and 4: HOSPITAL Dedicated wholly to Women
Page 5 and 6: Labour Epidural Analgesia Dedicated
Page 7 and 8: Massive Obstetric Hemorrhage “Obs
Page 9 and 10: Maternal mortality in India: WHO st
Page 11 and 12: • 585000 maternal deaths per year
Page 13 and 14: Obstetrical Hemorrhage Blood loss a
Page 15 and 16: The position of a woman in any civi
Page 17 and 18: Major Obstetric Haemorrhage As an A
Page 19 and 20: Admission Conscious, incoherent D
Page 21 and 22: Simultaneous Team Work History Taki
Page 23 and 24: Emergency Treatment IM Carboprost
Page 25: Lab Results Haemoglobin Undetectabl
Page 28 and 29: SURVIVING BLOOD LOSS
Page 30 and 31: Categorization of Acute Hemorrhage
Page 32 and 33: Remember… Blood Loss % Loss Respo
Page 34 and 35: Resuscitation • 2 large bore IV c
Page 36 and 37: Targets of Resuscitation Mental sta
Page 38 and 39: Platelet depletion Factor depletion
Page 40 and 41: Obstetric Hemorrhage Pathophysiolog
Page 42 and 43: Fluid Choices Fluid Type Comments N
Page 44 and 45: Very important to maintain adequate
Page 46 and 47: Severe Ongoing Hemorrhage Worsening
Page 50 and 51: The Trigger… Blood & Blood Compon
Page 52 and 53: Diagnosis of Coagulopathy Activatio
Page 54 and 55: Packed Cell Transfusion • PRB‟c
Page 56 and 57: Intra - Op Findings • Uterus enla
Page 58 and 59: Post Operative - Findings • Oozin
Page 60 and 61: Post Op Period - Stormy Prevent MOD
Page 63 and 64: Post Op Period Weaned off ventilato
Page 65 and 66: Incidence PPH : 4 - 6 % of deliveri
Page 68 and 69: Massage Uterus Protocol Soft Atonic
Page 70 and 71: 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 122 and 123:
• Call for help Communication Tea
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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