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Obstetric Emergencies - Postpartum Hemorrhage and Hypertension PowerPoint Presentation

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Published on : Jul 18, 2021 | Views : 1708 | Downloads : 7

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Obstetric Emergencies Postpartum Hemorrhage and Hypertension Annelee Boyle, MD, FACOG Assistant Professor Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine University of Virginia School of Medicine
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Disclosures
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Pregnancy-related mortality in the United States: 1987-2010 Source: CDC Pregnancy Mortality Surveillance System
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Obstetrics and Gynecology, May 2014
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Causes of pregnancy-related death in the United States: 2006 -2010 Source: CDC Pregnancy Mortality Surveillance System
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Maternal mortality is only the tip of the iceberg
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Obstetrics and Gynecology, February 2012
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93% of deaths preventable! Berg et al. Preventability of pregnancy related deaths: results of a statewide review. Obstet Gynecol 2005; 106:1228-34. Common mistakes: Under-recognition of blood loss Under-recognition of hypovolemia Failure to act decisively Failure to restore blood volume Postpartum Hemorrhage
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Recognize the extent of blood loss Dildy et al, Estimating Blood Loss: Can Teaching Significantly Improve Visual Estimation? Obstetrics & Gynecology. 104(3):601-606, September 2004.
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Recognize the extent of hypovolemia
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Obstetrics and Gynecology, May 2014
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Systolic BP <90 or >160 Diastolic BP >100 Heart Rate <50 or >120 Resp Rate <10 or >30 Oxygen Sat <95% on room air Urine output <35ml/hr for 2 hours Agitation, confusion, or unresponsiveness Shortness of breath or a non-remitting headache in a patient with pre-eclampsia Mhyre et al. The maternal early warning criteria: a proposal from the national partnership for maternal safety. Obstet Gynecol 2014;124:782-6. Early warning signs
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Act decisively/Restore blood volume
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Rule number one: Postpartum Hemorrhage is a definition, not a diagnosis! Post-Partum Hemorrhage
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Actively manage the third stage of labor Pearls for Atony
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Consider additional utero-tonics for those at highest risk of PPH Pearls for Atony
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Have a low threshold for going to the OR for repair. Pearls for Lacerations
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Source: California Maternal Quality Care Collaborative
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60% of deaths are preventable! Berg et al. Preventability of pregnancy related deaths: results of a statewide review. Obstet Gynecol 2005; 106:1228-34. Common mistakes: Failure to adequately control blood pressure Failure to recognize HELLP syndrome Failure to diagnose and treat pulmonary edema Preelcampsia
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Systolic BP <90 or >160 Diastolic BP >100 Heart Rate <50 or >120 Resp Rate <10 or >30 Oxygen Sat <95% on room air Urine output <35ml/hr for 2 hours Agitation, confusion, or unresponsiveness Shortness of breath or a non-remitting headache in a patient with pre-eclampsia Mhyre et al. The maternal early warning criteria: a proposal from the national partnership for maternal safety. Obstet Gynecol 2014;124:782-6. Early warning signs
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Control Blood Pressure
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Control Blood Pressure
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Hi Annelee. Hope you’re doing well and liking your new job. It’s 10:30 pm here and for me, that’s the middle of the night so rather than be friendly and “chat”, I’m going to get straight to the point – it’s business… So our hospital protocol essentially regurgitates ACOG, but it doesn’t specify that it is for use only with preeclamptic/eclampic patients. Would you use it for someone with chronic HTN also, barring known renal disease or other cause of the HTN? Thanks! Love, Aunt Crunchy
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Recognize HELLP Syndrome
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The most important paper on HTN in pregnancy in the last year
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SBP >160 DBP >110 Platelets < 100,000) LFTs >2x normal Creatinine > 1.1 Pulmonary edema New-onset cerebral or visual disturbances Right upper quadrant pain American College of Obstetricians and Gynecologists. Hypertension in pregnancy: executive summary. Obstet Gynecol 2013;122:1122–31. Severe Features of Preeclampsia
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Recognize and treat pulmonary edema
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“If you’re going down take everybody else with you.” Susan Modesitt, Gyn Oncologist The UVA way (or maybe it was UNC)
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David Barker 1938-2013
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The Barker Hypothesis The Thrifty Phenotype Fetal Origins Hypothesis
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Intrauterine Growth Restriction
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30 years from now
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Thank you!!!