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dr_fleischer_obstetric_hemorrhage_presentation

dr_fleischer_obstetric_hemorrhage_presentation - Maternal...

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    Maternal Mortality   - O bs te tric al He m o rrhag e  - Dr. Adiel Fleischer Chief Maternal Fetal Medicine NS-LIJ Health System
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    Maternal Mortality Maternal Mortality -All pre g nanc ie s - -All pre g nanc ie s - Etiology M. M. Hemorrhage 28.7% Embolism 19.7% P.I.H. 17.6% Infection 13.1% Cardiomyopathy 5.6% Anesthesia complic 2.5% Others 12.7%
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    Prepare   Handle Maternal Mortality   Peripartum Hemorrhage (PPH) Predict - O bs te tric al He m o rrhag e  -
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    Maternal Mortality - O bs te tric al He m o rrhag e  - Identify Patients at Risk Multidisciplinary “Hemorrhage protocol”   Clinical managemen t of PPH
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    Maternal Mortality - O bs te tric al He m o rrhag e  - 1.-Identify pat. at risk -Pl previa/accreta - Anticoagulation Rx - Coagulopathy - Overdistended uterus - Grand multiparity - Abn labor pattern - Chorioamnionitis - Large myomas - Previous history of PPH
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    Maternal Mortality - O bs te tric al He m o rrhag e  - 1.- Prepare for PPH 2.- Optimize patient’s hemodynamic status 3.- Timing of Delivery 4.- Surgical planning 5.- Anesthesia /I.V. access/ invasive monitoring 6.- Modify obsterical management 7.- Increased postpartum/postop surveillance Patients at  risk Pre-delivery management
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    Maternal Mortality - O bs te tric al He m o rrhag e  - 1.- Prepare for PPH  -Nursing  -Anesthesia  - Surg assistance  - Others (I.R.) Drugs/Equipment -Methergine -Hemabate -Cytotec -Colloids - Blood/Bl.products -Surg. Instruments -Hemostatic ballons    ( Cook, S-B, Foley) Personel
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    Maternal Mortality - O bs te tric al He m o rrhag e  - 1.- Prepare for PPH 2.- Optimize patient’s hemodynamic status 3.- Timing of Delivery 4.- Surgical planning 5.- Anesthesia /I.V. access/ invasive monitoring 6.- Modify obsterical management 7.- Increased postpartum/postop surveillance Patients at  risk Pre-delivery management
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    Maternal Mortality - O bs te tric al He m o rrhag e  - 2.- Optimize hemodynamic status 1.- Acute isovolemic hemodilution 2.- Acute hypervolemic hemodilution 3.- Autologous donation 4.- Preoperative transfusion
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    Maternal Mortality - O bs te tric al He m o rrhag e  -   Acute  hemodilution Decreases pre-op Hb  concentration Lower RBC’s loss For same blood volume  lost Transfusion rates           -  Final Hct’s
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    Maternal Mortality - O bs te tric al He m o rrhag e  - 1.- Acute isovolemic hemodilution Withdraw 2-4u. of Blood                   Replace the volume with crystaloids                   Lower the pre-op Hct                   Replace the blood at end of surgery 2.- Acute hypervolemic hemodilution Admin 1500-2000cc Crystaloids                      Hemodilution (Lowers pre-op Hct)
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    Maternal Mortality - O bs te tric al He m o rrhag e  -
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    Maternal Mortality - O bs te tric al He m o rrhag e  -
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