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Published byLea Tronson
Modified over 2 years ago
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
Management of Type II Placenta Previa
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.
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.
Nahida Chakhtoura, M.D.. Postpartum hemorrhage (PPH): leading cause of maternal mortality worldwide Prevalence rate: 6% Africa has highest prevalence.
Obstetric Hemorrhage Abike James MD Assistant Clinical Prof. Obstetrics and Gynecology University of Pennsylvania.
Postpartum Hemorrhage(PPH) 产后出血 林建华. Major causes of death for pregnancy women （ maternal mortality) Postpartum hemorrhage （ 28%) heart diseases pregnancy-induced.
Postpartum Hemorrhage Christopher R. Graber, MD Salina Women’s Clinic 21 Feb 2012.
Postpartum Hemorrhage (PPH) and abnormalities of the Third Stage Sept 12 – Dr. Z. Malewski.
Hemorrhagic diseases. Lesions of the blood vessels Lesions of the blood vessels Abnormal platelets Abnormal platelets Abnormalities in the coagulation.
Postpatrum Hemorrhage and Third Stage Emergencies
Brad Beckham T4. Definitions Major blood loss Hemoglobin concentration below 6-10 g/dl Massive transfusion in adults >9 erythrocyte units within 24h.
Massive transfusion: New Protocol
Haematology. Help I need blood! Both O negative and group specific are unsuitable for patients with antibodies…
ROLE OF INTENSIVIST IN CARE OF CRITICALLY ILL MOTHER Kenyatta National Hospital & UoN, College of Health Sciences Symposium Venue: Lecture Theatre III.
By Dr. Ahmed Mostafa Assist. Prof. of anesthesia & I.C.U.
Leanna R. Miller, RN, MN, CCRN-CSC, PCCN-CMC, CNRN, CEN, NP Education Specialist LRM Consulting Nashville, TN.
Coagulation failure in pregnancy
Massive Transfusion Mary Jo Drew, MD, MHSA Chief Medical Officer Pacific Northwest Blood Services Region.
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.
D - DEATH I - IS C - COMING DIC is an important contributor to maternal mortality and morbidity.
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