dr_fleischer_obstetric_hemorrhage_presentation

dr_fleischer_obstetric_hemorrhage_presentation - Maternal...

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Unformatted text preview: Maternal Mortality - O b s te tric a l He m o rrhag e - Dr. Adiel Fleischer Chief Maternal Fetal Medicine NS-LIJ Health System 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% Prepare Handle Maternal Mortality Peripartum Hemorrhage (PPH) Predict- O b s te tric al He m o rrhag e - Maternal Mortality- O b s te tric a l He m o rrha g e - Identify Patients at Risk Multidisciplinary Hemorrhage protocol Clinical managemen t of PPH Maternal Mortality- O b s te tric a l He m o rrha g 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 Maternal Mortality- O b s te tric a l He m o rrha g e - 1.- Prepare for PPH 2.- Optimize patients 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 Maternal Mortality- O b s 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 Maternal Mortality- O b s te tric al He m o rrhag e - 1.- Prepare for PPH 2.- Optimize patients 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 Maternal Mortality- O b s 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 Maternal Mortality- O b s te tric a l He m o rrha g e - Acute hemodilution Decreases pre-op Hb concentration Lower RBCs loss For same blood volume lost- Transfusion rates - Final Hcts Maternal Mortality- O b s te tric a l He m o rrha g 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) Maternal Mortality- O b s te tric a l He m o rrha g e -...
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dr_fleischer_obstetric_hemorrhage_presentation - Maternal...

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