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Fluid Management of Maternal Hemorrhage Dr.Hantoushzadeh
2 Maternal Mortality -All pregnancies- EtiologyM. Hemorrhage28.7% Embolism19.7% P.I.H.17.6% Infection13.1% Cardiomyopathy5.6% Anesthesia complic2.5% Others12.7%
3 1- Identify risk - Placenta previa/accreta -Anticoagulation Rx -Coagulopathy -Over distended uterus -Grand multiparity -Abnormal labor pattern -Chorioamnionitis -Large myomas -Previous history of PPH Maternal Mortality - Obstetrical Hemorrhage -
4 O 2 Delivery = C.O. x Sa O 2 x Hb% Fluid management Oxygenation Transfusion Maintain aerobic metabolism Hemorrhagic Shock - Management - CO = cardiac output SaO2 = Systemic arterial oxygen saturation
5 ClassBlood Loss Volume Deficit SpxRx I < 1000 cc15% Orthostatic tachycardia Crystalloid II 1001-150015-25% Incr. HR, orthostasis, mental Decr cap refill Crystalloid, III 1501-250025-40% Incr HR, RR Decr BP, Oliguria Crystalloid Colloid, RBCs IV > 2500 > 40% Obtunded Oliguria/anuria CV collapse RBC, Crystalloid, Colloid Managing blood loss by hemorrhage classification
6 Blood Components ProductVolumeComponents Indication/ Utility Whole blood450-500 ccHct. 36-44%1u =1g/dl Hb PRBC200-250 ccHct. 70-80%1u = 1g/dl Hb Platelets30-50ccPlatelets WBC Ag1u = 5000uL FFP100cc Fibrinogen, clotting factors PT, PTT> 1.5 x nl, INR > 1.6 Cryo- precipitate 50-75cc Factor 8c, Von Willebrand’s factor, Fibrinogen Fibrinogen replacement
Factor Replacement Therapy VWF Hemophilia Acquired Inhibitors Plasmapheresis
Platlets transfusion ITP Acute Fatty Liver HELP Sever Preeclampsia IUFD Placental Abruption
Maternal Mortality and Hemorrhage Gina M. Brown, MD NYC Department of Health and Mental Hygiene Bureau of Maternal, Infant and Reproductive Health.
Dr Ahmed abdulwahab. Hemorrhage is still one of the leading cause of maternal mortality all over the world DEFINITION Primary post partum hemorrhage.
Postpartum Hemorrhage Dr. Alongkone Phengsavanh. Objectives Define and discuss risk factors and causes Describe management and prevention.
Brad Beckham T4. Definitions Major blood loss Hemoglobin concentration below 6-10 g/dl Massive transfusion in adults >9 erythrocyte units within 24h.
PLACENTAL ABRUPTION ASSOCIATE PROFESSOR IOLANDA BLIDARU MD, PhD.
Massive Transfusion in Trama By R1 彭育仁. Brief History(1) 26 y/o male came to our ER due to massive bleeding from cutting wound over right neck and left.
Obstetric Hemorrhage Anne McConville, MD. The Direct leading cause of pregnancy related mortality in the United States is – A) Failed Intubation – B)
Nahida Chakhtoura, M.D.. Postpartum hemorrhage (PPH): leading cause of maternal mortality worldwide Prevalence rate: 6% Africa has highest prevalence.
Postpatrum Hemorrhage and Third Stage Emergencies.
Critical Care in Life Threatning Obstetrics Emergencies – Can Save Mother and Child Dr. Sharda Jain Chairman, Dept of O/G - Pushpanjali Crosslay Hospital.
Hemorraghic Shock Sara Parker MD VCU Trauma Conference STICU Fellow July 8, 2015.
Massive transfusion: New Protocol Bhavani Shankar Kodali MD Anesthesiologist-in-Chief, Interim Chairman Brigham and Women’s Hospital Associate Professor.
MASSIVE TRANSFUSION OB ROUNDS, JAN RECOMMENDATIONS FOR MASSIVE TRANSFUSION Assuming: Previously healthy 70 kg adult No cardiac disease Not anaemic.
Postpartum Hemorrhage Abdulah Al-Tayyem;MD;JBOG Consultant Ob&Gyn Urogynaecology Zarka Govern. Hospital.
Maternal Mortality - Obstetrical Hemorrhage - Dr. Adiel Fleischer Chief Maternal Fetal Medicine NS-LIJ Health System.
Definition of Massive Transfusion Replacement of a blood volume equivalent within 24hr Transfusion>10 unit within 24 hr Transfusion > 4 units in 1 hr.
Postpartum Hemorrhage Christopher R. Graber, MD Salina Women’s Clinic 21 Feb 2012.
Chapter 33 Postpartum Complications Mosby items and derived items © 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
By Dr. Ahmed Mostafa Assist. Prof. of anesthesia & I.C.U.
D - DEATH I - IS C - COMING DIC is an important contributor to maternal mortality and morbidity.
DR G SIYAKA Obstetric anaesthesia OUTLINE Physiological changes of pregnancy Anaesthesia for caesarean delivery Analgesia for labour Complications.
Intern 謝旻翰. Introduction (I) Benefit –Volume restoration, improved O2 carrying capacity Risk –Transfusion reaction, blood-bore pathogen, limited supply,
Blood and Blood Products. Whole Blood n Contents –RBC’s –WBC’s –Platelets –Plasma –Clotting factors.
Definition of spectrum of sepsis Pathophysiology of sepsis Early Goal Directed Therapy.
Postpartum Complications Perinatal Practicum. Common postpartum complications Postpartum hemorrhage Hypertensive disorders Infection Venous disorders.
Post Partum Hemorrhage PPH. Definition: Blood loss in excess of 500 ml with vaginal delivery or in excess of 1000 ml following delivery by caesarian.
Postpartum Haemorrhage. Definitions Primary PPH – blood loss of 500ml or more within 24hours of delivery. Secondary PPH – significant blood loss between.
4th year medical students Blood Component Therapy Salwa I Hindawi MSc FRCPath CTM Director of Blood Transfusion Services KAUH. Jeddah.
Obstetric Hemorrhage Abike James MD Assistant Clinical Prof. Obstetrics and Gynecology University of Pennsylvania.
Whole Blood After transfusion with one unit of whole blood, 1.0g/dL hemoglobin indications for transfusion with whole blood are hemorrhagic shock with.
Massive Transfusion Mary Jo Drew, MD, MHSA Chief Medical Officer Pacific Northwest Blood Services Region.
Amniotic Fluid Embolism Women ’ s Hospital School of Medicine Zhejiang University Wang Zhengping.
Postoperative Challenges in Neurocritical Care SNACC and NCS Joint Presentation Andrea Orfanakis, MD Oregon Health and Science University Multi-Level Spinal.
Shock and its treatment Jozsef Stankovics Department of Paediatrics, Medical University of Pécs 2008.
Post Partum Hemorrhage Akmal Abbasi, M.D.. Post Partum Hemorrhage Obstetric Haemorrhage:Ranks as the First cause of maternal mortality accounting for.
Cristy M. Thomas FNP-BC University of Nevada School of Medicine University Medical Center, Las Vegas NV Nevada’s Only Level 1 Adult Trauma, Level 2 Pediatric.
Transfusion in Cardiopulmonary Bypass. Blood Use & Cardiac Surgery 1971 – average 8 units RBC per case Late 1980’s – Texas Heart Institute 1.4 units per.
Antepartum Hemorrhage Family Medicine Specialist CME University of Health Sciences.
In the name of GOD. POSTPARTUM HEMORRHAGE Dr. Farahnaz Keshavarzi Ob. & Gyn. Department Kermanshah University of Medical Sciences.
SHOCK. DEFINITION Profound hemodyamic and metabolic disturbance characterized by failure of the circulatory system to maintain adequate perfusion of vital.
Anesthetic Management of The Trauma Patient. Baseline Prior To OR BP 90/40 | HR 130s | Intubated CV Left chest ant & post wounds/ left calf wound Right.
PRINCIPLES OF FLUIDS AND ELECTROLYTES. Fluid Compartments Example: 70-kg male Total Body Water: 42,000 mol(60% of BW) Intracellular: 28,000 mL(40%
BLOOD TRANSFUSION Ferdi Menda,M.D. Assistant Prof of Anesthesiology Yeditepe University.
Dr Dalia Juneenath St 3 02/09/2015. Bleeding In Pregnancy Bleeding in early Pregnancy Antepartum haemorrhage (APH) Post partum Haemorrhage (PPH)
Early goal directed therapy in the treatment of sepsis Nouf Y.Akeel General surgery demonstrator Saudi board trainee R3.
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 1 Abnormal Pregnancy CAPT Mike Hughey, MC, USNR.
Shock. Anatomy and Physiology of Cardiovascular System CO = SV * HR (Normal = l/min) MAP = Dist. Pressure + 1/3 Pulse Pressure (Normal =
Diagnosis and Management of Shock. 1 Copyright 2008 Society of Critical Care Medicine Objectives Identify the main categories of shock Discuss goals of.
Placental Abruption Liu Wei Department of Ob & Gy Ren Ji hospital.
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