Discussions for Module 8: Management of Post Partum Hemorrhage

Questions are answered by module author: Sharon Davies MD FRSPC

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Question:

If the slow ooze you mentioned was not responding to recombinant factor v11 a (or if not available), what will be your line of management? Thanks for the excellent case discussion.

1/1/2007 1:13:52 AM P.V.


Dr. Davies replies:

Since the coagulopathy and anemia were corrected, the other possible drug to try would be tranexamic acid. One would expect that hematology would be consulting by this point and could advise on the use of this drug in this patient. We have used it successfully at this institution for a Jehovah's Witness patient with a major PPH. Aside from that, and of course, continued transfusion to maintain the hemaglobin and keep the coagulopathy under control, the only other option becomes a surgical decision. However, one other approach before surgery could be angiography. If available, one might be able to determine if there is a possibility that embolization would useful, ie, that there are one or two vessels from which the bleeding originates that could be embolized.

 

Question:

In the case you described what was the cause of the cardiac arrest? It looked like sufficient resuscitation within the period available was attempted by the attending teams. Thank you for the detailed review of uterine atony.

12/22/2006 2:32:28 PM U.T.


Dr. Davies replies:

I believe that this patient was hypovolemic, despite the initial response to the fluid bolus. Given the fact she required 8 more units of blood (plus other products) and still ended up with a Hgb of 86 on arrival to ICU suggests that there was ongoing losses that needed to be replaced. The rhythmn at arrest was PEA which is again consistent with hypovolemia.





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