Term
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Definition
1. Evaluate:
A. hemodynamics status (BP, pulse, color, cap refill)
B. Bimanual examination for uterine atony (look for retained placental fragments, uterine wall for rupture)
C. Inspect perineum, vulva, vagina, and cervix (for lacs, hematomas, inversions; get assistance for exposure (???), and reinspect the placenta)
D. Assess clotting
2. Targeted interventions
A. Uterine atony with:
-immediate bimanual massage
-administer uterotonics (oxytocin IV 10-40 units/1 L of NS or LR, continuous,other drugs on another card)
-operative measures
-Uterine compression sutures
-sequential arterial ligation or selective arterial embolization
B. Retained placenta
-manual removal and manage atony
-US assessment/guidance to make sure complete removal
-suction currettage
-Maintain suspicion for accreta
C. Genital tract lacs and hematomas
-repair lacs immediately
-exposure critical (get assistance and move to OR)
-no blindly placed sutures
-packing PRN
-observe stable, asx hematomas
D. Coagulopathy
-appropriate factor replacement
-ID underlying cause
-hemorrhage, infxn, amniotic fluid embolization, other
3. Monitor and maintain circ
A. Establish IV access-2large bore
B. Type and cross
C. Begin/increase crystalloid infusion
D. Assess for clots/coat profile |
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