Obstetric Hemorrhage: Evidence-based Management and Recent Advances Sheela V Mane, Shobha N Gudi, Priyanka Dilip Kumar
INDEX
ABCDEFGHIJKLMNOPQRSTUVWY
Page numbers followed by b refer to box, f refer to figure, fc refer to flowchart, and t refer to table.
A
ABC score 279
Abdominal pregnancy, laparoscopic view of secondary 95f
Abortion 42, 131
classification of 97fc
common cause of 131
complications of unsafe 203
incomplete 43, 97
medical methods of 134
spontaneous 138
varieties of 97fc
Abruptio placenta 33, 40, 44, 65, 143, 162, 169, 260, 266, 268
Absorbable gelatin matrix 220
Absorbent delivery mats 4
Accredited Social Health Activists 5
Actinomycin-D 120
Activated partial thromboplastin time 166, 200, 251, 257, 269, 274, 280
Acute hemolytic transfusion reaction 70
Acute lung injury, transfusion-related 68, 276
Acute respiratory distress syndrome 39, 40, 68
development of 168
Adenosine 5-diphosphate agonists 253
Adequate fluid resuscitation, signs of 57
Adherent placenta 28
Adjuvant medical therapy 113
Airway mucosa 78
Alcohol 163
consumption 162
Alopecia 109
Amenorrhea 42
history of 94
American College of Obstetrics and Gynecology 208, 210
Amniocentesis 163
Amniotic fluid 64
embolism 65, 249, 265, 266
Anemia 39, 165, 193
correction of 67
risk of 9
severe 40
Anesthesia 37, 156, 187
general 194
Antepartum arterial balloon occlusion 235
Antepartum hemorrhage 33, 42, 43, 141, 143, 162, 204
Antepartum period 173
Antepartum uterine rupture 174
Antibiotics 104, 228
Anticipation 31
Anti-D prophylaxis 68
Antifibrinolytic
agent 241
clinical randomisation of 241
Antimicrobial therapy 104
Aorta clamp 187f
Aortic compression 7, 210
Arterial balloon occlusion 235
Arterial blood gas 56, 280
Arterial embolization 159
Artery, internal 214f
Aspirin 194
Assisted reproductive technology 90, 114, 143
Atonic postpartum hemorrhage 6t, 12, 197, 203, 260
management of 50
Atonic uterus, management of 135b
Atony 99
Audit
cycle 12
process, types of 12
Automated external defibrillator 32
Auxiliary nurse midwife 5
B
Backache 165
Bacteroides fragilis 102
Bakri balloon 25, 209f
Balloon
condom catheter 50, 51f
tamponade 7, 157, 210
Bernard-Soulier syndrome 254
Beta human chorionic gonadotropin 87, 112, 127
Bimanual compression 7, 210
suture 82f
Bimanual palpation 124
Biochemistry profile 280
Birth
trauma 65
weight, low 166
Bladder fistula, formation of 110
Bleeding 219
anatomic control of 284
causes of 4
control of 119
disorders 133, 138, 194, 225, 226, 249, 251, 256
inherited 250
management of 258
first trimester 163
history of 143
intraperitoneal 121, 235f
life-threatening 121
posthysterectomy 136
reduce
intraoperative 187
risk of 154
symptoms 268
third stage 31
uncontrolled 90
warning bout of 182
Blood 3, 64, 200
bag 69
bank 280
collected, measuring 61
collection vacutainer and tubes 48f
color of 144
components 66, 71
therapy 53f, 67, 200t
types of 66
count
complete 166, 280
full 6, 65
culture 227
grouping 166
groups switches chart 283, 284f
loss 45, 54, 60, 61, 98, 201b
acute 66
assessment of 60, 63f, 64, 198t
estimation of 4, 64, 77, 204, 237
excessive 262
measurement of 46, 63
monitoring 4
objectifying 61
quantification of 64
quantify 60
volume 63
pressure 6, 18, 76, 165, 197, 201, 203, 230, 279
raised 165
systolic 39, 54, 61, 198, 279
product 52, 69
transfusions 131
use of 215
replacement 271
strategies 283
sample bottles 5
set 5
transfusion 4, 6, 57, 68, 71, 201, 279, 280
in management, role of 65, 66
indications of 66
purpose of 66
role of 52
urea nitrogen 167
use of 215
volume 76
loss 204
restoration of 271
warming 69
B-lynch sutures 211f
Body
mass index 163, 204
surface area 88
Brass V drape 45f, 62f
British Committee for Standards in Haematology guidelines 280
Broad-spectrum antibiotic coverage 137
Bronchospasm 49
Bucket-handle tears 222
C
Cancer 268
Cannula
large intravenous 65
test 99
Carbapenem 104
Carbetocin 48, 239, 241
Carboprost 49
Cardiac disease 40
Cardiac overload, transfusion-associated 276
Cardiology 37
Cardiotocography 163, 165, 169
Cardiovascular system 76
Catheter 5
Cell salvage 215, 280
Cellular hypoxia 75
Central nervous system 267, 278
Central venous
catheters 47f
pressure 65
Cephalic version, external 162
Cervical
ectopic pregnancy 90, 108, 123, 125t, 128
classification 125
diagnosis 124
differential diagnosis 125
etiopathogenesis 123
incidence 123
management 126
medical management 126
risk factors 123
treatment for 126fc
erosions 153
injuries 99, 133, 136
laceration 99, 132, 197
lesions 225
polyp 143, 151
pregnancy 87
incidence of 123
management of 90
preparation 101
priming 137
ripening 101
stenosis 134
tear 222
minor 222
tumor 125
Cervicoisthmic apposition sutures 213f
Cervix 123
Cesarean
delivery 63, 209
planned repeat 171
hysterectomy 159
steps for 159
scar ectopic pregnancy 95f
scar pregnancy 91, 107, 108, 109t
diagnosis of 108
number of 91
treatment modalities for 109t
types of 108
ultrasound of 108b
section 18, 21, 226, 259
number of previous 143
previous lower segment 172
Chemotherapy 121
Childbirth 21
Cho's square sutures 212, 212f
Chorioamnionitis 162, 163
Choriocarcinoma 119, 121, 121f, 225, 226
bleeding in 121
Chorionic vessels 151f
Circulatory failure, management of 56
Circulatory overload, transfusion-associated 70, 216
Clamp, cut and drop technique 261
Clindamycin 104
Clinical audit 12, 17
process of 12
Clinical observation tests 268
Clostridium
perfringens 228
welchii 102
Clot lysis test 268
Clot retraction test 268
Clotting factor correction 67
Coagulation
activation 268
disorders 65, 197
failure 31
screen 6
status, restoration of 271
study 166
Coagulopathy 99, 200
early trauma-induced 282
in pregnancy, pathophysiology of 77
management of 168
risk of 6
Cocaine 163
abuse 162
Colloid 47, 200, 210
Color Doppler 148, 155, 227
Community rehabilitation centers 38
Component therapy, role of 276
Comprehensive emergency obstetric care 205
Compression sutures 157, 209
hemostatic 199
use of 158
Computed tomography scan 227, 230
Connective tissue disorders 255
Constrict placental bed vessels 81
Consumptive coagulopathy 166, 267
Continuous electronic fetal heart monitoring 167
Conventional color Doppler 150f, 151f
Cord
insertion, marginal 152f
traction, controlled 194
Cornual pregnancy 91, 114
Cornual wedge resection 112
Cornuostomy 91, 112
Corticosteroids, antenatal 176
Cotton swabs 5
Couvelaire uterus 85f
Crash kit 46, 49, 50f
C-reactive protein 103, 227
Creatinine 167
Cryoprecipitate 58, 66, 200, 272, 281
Crystalloid 75, 200, 210
Cyclophosphamide 120
Cytomegalovirus 69
D
D-dimer 257, 269, 274
elevation 268
Dead fetus syndrome 266
Decidua, deficiency of 86, 132
Delivery
assisted 219
mode of 155
normal 121
timing of 176
Demography, clinical governance and audit 1
Dengue hemorrhagic fever 235f
Devascularization
site of 214f
stepwise 212
Diabetes 37, 40
mellitus 163
gestational 39, 180
Digital subtraction angiography 230
Dilutional coagulopathy 267
Disseminated intravascular coagulation 7, 157, 208, 228, 230, 249, 256, 260, 265, 266, 268t, 269t, 274t, 279
diagnosis of 68
etiological factors of 265
pathophysiology of 267
progression of 268f
risk of 105
systemic manifestations of 267t
Disseminated intravascular microthrombosis 265
Dopamine 57
Double-balloon catheter 242
Drugs 22, 194
E
Early pregnancy 107
bleeding in 42, 44, 119
Eclampsia 40
Ectopic gestation sac 89
Ectopic pregnancy 40, 65, 87, 88t, 94f, 123
abdominal 91
expectant management of 87
history of 93
management of 87
medical management of 87
nontubal 90
preventing hemorrhage in 87
ruptured 43
surgery, type of 89
surgical management of 89
unruptured 43
Elastometry
extrinsic 270
intrinsic 270
Electric vacuum aspiration 134
Electronic fetal monitoring 169
Elevated liver enzyme 39, 40, 149, 249, 255, 266
Embolization coil 233f
Embryo transfer 107
Emergency
codes and alerting systems 28f
kits for safety 24
obstetric care 10
peripartum hysterectomy 259
surgical principles of 261
tray 46
Empty uterine cavity 125f
End organ damage 75
Endometrial cavity 227
normal 227
Endomyometritis 102
Endotoxic shock management 101b
Endovascular management 231
Episiotomy 194, 197, 221
Ergometrine 6, 49, 199, 241
Erythrocyte sedimentation rate 227
Escherichia coli 102, 256
Ethylenediaminetetraacetic acid 55
Etoposide 120
F
Factor eight inhibitor bypass activity 251
Fallopian tube 87, 89
arteriography of 83f, 84f
interstitial part of 90
Fatty liver, acute 266
Febrile nonhemolytic transfusion reaction 70
Federation of Obstetric and Gynaecological Societies of India 12, 194
Fertility
after treatment 128
after uterine arterial embolization 237
sparing treatment 90
Fetal
death 265
management of 102
distress 165
growth restriction 166
heart rate 182
abnormal 173
macrosomia 194
movements, loss of 165
status monitoring 167
Fetus
and placenta 75
delivery of 175
normal 44, 119
Fibrin
degradation product 68, 266, 269, 274
deposition 267
sealants 220
Fibrinogen 200, 257, 269, 274
concentrate 272
correction of 67
deficiency, severe 252
level 269
thromboelastometry 270
Fibrinolysis 267, 268
Fibrinolytic agents 272
Fibroid 163
uterus 194
Filling bladder 159
First trimester complications 107
First-line drug 48
Fluids 3, 197
therapy 47, 200t
transfusion 6
Foley's bulb 262
Foley's catheter 7, 65
Folic acid
deficiency 162
supplementation 193
Fresh frozen plasma 6, 53, 58, 66, 167, 200, 252, 271, 274, 279, 281
transfusion of 68
Fundal rupture, intraoperative findings of 174f
G
Gefitinib 90
Gelatin sponge 234
Genital tract 9, 31, 200, 233, 234
Genital tumor 143
Gentamicin 104
Gestational age 181
Gestational sac 87
implantation of 91
Gestational trophoblastic
disease 119
bleeding in 119
neoplasia 119
Glanzmann thrombasthenia 253
Glomerular filtration rate 278
Glycoprotein, deficiency of 253
Golden hour 193
concept and first response 193
Grand multiparity 162, 194
Gravimetric method 62
Great arteries 4
Growth assessment protocol 25
H
Hayman's sutures 210, 211f
Heart
disease 37, 39
rate 279
stabilizing 9
Heat stable oxytocin 239
Heavy bleeding, control 121f
HELLP syndrome 40, 65
Hematocrit 166
Hematological parameters, normalization of 284
Hematological system 76, 76f
Hematomas 218
incidental 115
infralevator 222
intra-amniotic 166
management of 222
marginal 166
size of 115
Hematometra 100
Hematuria 173
Hemodynamic status, normalization of 284
Hemoglobin 17, 31, 39, 105, 200, 203, 227, 235f
Hemogram, complete 55
Hemolysis 39, 40, 149, 249, 255, 266
Hemolytic uremic syndrome 255, 256
Hemoperitoneum 93f
laparoscopy in presence of 89
Hemophilia
A 226, 250, 251
acquired 251
B 226, 250, 251
Hemorrhage 19, 55, 99, 102, 131, 203
abortion-related 134
abortion, management of 99
acute 144
after abortion 100t
amount of 143
causes of 99
class 204
classification of 61t
early 144
estimation of 134
high risks of 108
in early pregnancy 73
intracranial 58
nature of 143
prophylaxis 92
resolving 144
risk group 100
risk of 90
sepsis, and pregnancy 35
specific issues of 98
uncontrolled 57, 91
Hemorrhagic emergencies 4
Hemostasis 128
disorders of 249
monitoring 52
Hemostat drugs, administration of 207t
Hemostatic status 256
Heparin 194
Hepatic function 88
Hepatitis
B 68
C 68
Heterogeneous signal intensity within placenta 148
Heterotopic pregnancy 87, 92, 111
treatment of 92
High dependency unit 18, 21, 37, 39-41, 206, 220
care 39t
management of 39
Homeostasis, principles of 265
Hospital emergency alerting systems 27
Hospital-acquired infection 26
Human chorionic gonadotropin 88, 126-128
production of 119
Human immunodeficiency virus 6, 68
infection 255
Hydatidiform mole, evacuation of 119
Hyperhomocysteinemia 162
Hypertension 19, 143, 266
chronic 162
gestational 163
pregnancy induced 65
severe 39
Hypertensive disorders 17, 40, 41, 203, 254
Hypoperfusion, acute 75
Hypotension 165
Hypothermia 159
Hypovolemia 159, 266, 276
Hypoxia 67
Hysterectomy 8, 109, 121f, 159, 175, 213, 216, 228
choice of 262
specimen of subtotal 120f
steps of 188
Hysteroscopic
excision 109
guidance 110
resection 90, 92, 95f
Hysterotomy, high vertical 172
I
Idiopathic thrombocytopenic purpura 254
Iliac artery
common 214f
external 214f
internal 81, 214f
right internal 84
Immune thrombocytopenia 255
In vitro fertilization 107, 263
program 123
Incision, site of 156
Infection
control systems 26
transfusion-related 70
Infusion syringe pump 48f
Initial fluid replacement 54
Intensive care unit 18, 31, 36, 37, 75, 186, 206, 279
International Federation of Obstetrics and Gynaecology 184
International normalized ratio 53, 166
International Society on Thrombosis and Hemostasis 269
Interstitial pregnancy 90, 111, 112, 113t
management of 112fc
treatment of 111
Interventional radiology 237
advantages of 237
selective arterial embolization 223
techniques 157, 230
Intracervical canal 125f
Intraoperative cell salvage 70
Intrapartum period 173
Intrauterine
balloon tamponade 158
use of 158
contraceptive device 123
fetal death 169
growth restriction 165
insemination 93
manipulator 90
pregnancy 93
tamponade 242
principles of 242
Intravenous infusion 4
Invasive mole 120f
bleeding in 120
Doppler appearance of 120f
Iron 193
J
Janani Shishu Suraksha Karyakram 10
Janani Suraksha Yojana 10
Jehova's witness 215
Jugular vein distention 70
K
Kerala Federation of Obstetrics and Gynaecology 185
Kerr's incision 210
Kidney injury, acute 40
Klebsiella 102
L
Labor
active management of third stage of 194, 260
after cesarean delivery, trial of 171, 263
and delivery complex 22f
delivery and recovery 24
number of 22
management of third stage of 31
obstructed 172
preterm 165
prolonged third stage of 194
unsupervised 172
ward 26, 195
complex, reception for 23
preparedness 195
safety in 21
trolley parking area 23
working station for 23
Laparotomy 174, 175, 175f
Left internal iliac artery 83
Left ovarian ectopic pregnancy, laparoscopic view of 94f
Left uterine artery 83, 84
angiography 234f
Lethal anomaly, without 44
Ligament artery, round 83
Liver 267
disorders 40
failure 235f
function test 55
Living ligatures 80f
Local embryocidal agents 110
Low molecular weight heparin 262
Low platelet
count 39, 40
syndrome 149, 249, 255, 266
Lower genital tract
hemorrhage 219
trauma 223
Lower left vaginal artery 83, 84
Lower segment cesarean section incision 75, 261
Lower uterine segment 173, 261
Lung 267
injury, transfusion-associated 216
M
Massive blood loss 67, 277, 277b, 281b
causes of 276b
indicators of 279
late complication of 284
management of 278, 280
Massive hemorrhage 90, 112, 182
management of 200
Massive transfusion 53, 58, 279, 282-284
therapy indication in 58t
Massive transfusion protocol 52, 207, 215, 276, 279, 281
activation of 279
benefits of 283
drawbacks of 283
rationale for 281
role of 281
termination of 284
Maternal anatomy 79
Maternal cardiovascular changes 77f
Maternal coagulopathy 162
Maternal complications 35, 91
Maternal death 17, 35, 36
causes of 33
surveillance and response 19
Maternal health 19
services 40
Maternal morbidity 60, 65, 175
severe acute 14, 18, 259
Maternal mortality 35, 65, 175
causes of 12, 87
rates 35
ratio 3, 12
Maternal near miss 18
Maternal pulse 165
Maternal respiratory changes 78f
Maternal resuscitation 34
Maternal safety pyramid 36f
Maternal vital signs stable 181
M-cross double ligation 159
Mean arterial pressure 61, 198
Medical abortion 98, 105
Medical management 4, 51
Medical Termination of Pregnancy 97, 131
Membrane, preterm premature rupture of 163, 180
Mental status 54
Metabolic acidosis 56
Metabolic alkalosis 56
Methergine 5
Methotrexate 87, 88, 88t, 112, 120, 126-128
administration 90, 92
doses of 109
therapy 127t
toxicity 89
treatment protocol 127t
Methylergometrine 5, 6, 49, 5, 207, 228
maleate 100
Metronidazole 104
Microangiopathic hemolytic anemia 255
Midwifery team safety principle 29
Minute ventilation 78
Miscarriage 42, 97
complete 43
inevitable 43
risk of spontaneous 115
threatened 43
Misoprostol 5, 49, 100, 135, 199, 207, 228, 241
prostaglandin 6
Mitochondrial deoxyribonucleic acid 164
Modified early obstetric warning 59f
score 46t, 59
system 219
Molar pregnancy 43
Monsel's solution 158
Morbidly adherent placenta 184, 189
Mortality compared 3
Moth-eaten hypoechoic areas 149
Mucositis, development of 88
Müllerian anomaly 114
Multidisciplinary teams 21
Multifetal gestation 143
Multiple gestation 163
Multiple organ system failure 278
Multiple placental infarctions 151f
Multiple pregnancy 194
Muscle cells 80
Myelosuppression, development of 88
Myometrial margin, loss of 149f
Myometrial nodules, highly vascular 120f
Myometrium 80
N
Nausea 109
Nausicaa compression suture 8
Near miss audit 18
Neonatal resuscitation bay 23
Nephrology 37
Nestor embolization coil 234f
Neurology 37
Nomenclature 184
Noninflatable antishock garment 51f
Noninvasive blood pressure 40
monitoring 48f
Nonpneumatic antishock garment 7, 199, 210, 216, 216f, 220
Nonstress test 168
Nonvertex presentation 163
Nuchal translucency 180
Nucleic acid testing 282
Nulliparous 90
O
O'leary sutures 8
Obesity 40
Obstetric anal sphincter repair 28
Obstetric care
complete 37
complexities of 21
Obstetric complications 37, 39
Obstetric handover board 26
Obstetric hemorrhage 13, 39, 42, 75, 79, 132, 265, 267
causes of 276b
clinical audit in 13, 15t
maintenance of 4
major 58, 65
management of 42, 65
massive 65
operating procedure for 31
prevention 42
Obstetric
high-dependency unit 35, 37, 38
hysterectomy 40, 235f
intensive care unit 37
management 33, 168
shock index 4
surgery, role of 67
Obstetrical bleeding, major 276
Obstetrical hemorrhage 276
O-Leary stitch 158
Oligemic shock, management of 75
Operation theater 21
shifting 208
Operative delivery 194
Operative trauma 65
Organ
dysfunction 39
response 278
Ovarian artery 81
right 83
Ovarian ligament 159
Ovarian pregnancy 87, 91
Ovarian reconstruction 94
Ovary, arteriography of 83f, 84f
Oxygen saturation 6
Oxytocics 3
Oxytocin 5, 6, 48, 49, 98, 100, 199, 207, 228, 241
administration of 157
analog 48
inadvertent use of 172
P
Pain 165
abdominal 107, 173
causes of 165
Palacios-Jaraquemada 81
Pallor 165
Partial thromboplastin time 68
Patient's urine 64
Pelvic
artery embolization, selective 228
hematomas 218
pressure pack 244
rest 116
vasculature 75
Penetrating injury 279
Periclitoral lacerations 221
Perinatal morbidity 176
Perinatal mortality 176
Perineal lacerations 194
Perineal tear repair 220
Peripartum hysterectomy 259, 262
bit of history of 260
elective emergency 262
Peripheral blood smear, Romanowsky stained 254
Peripheral villous trees 152f
Peritrophoblastic blood flow 125f
Periurethral lacerations 221
Photometric technique 61
Photometry 61
Piperacillin 104
Placenta 32, 63, 116
accreta 65, 85, 116, 147, 148, 155, 159, 185, 194, 243
evaluation of 104
rule out 181
spectrum 184
types of 85f
circumvallate 44, 163
increta 147, 235f
location of 154
low lying 147, 147f
percreta 147
position of 159
previa 33, 40, 44, 65, 79, 84, 85f, 116, 125, 143, 145, 146, 148f, 154, 156, 157, 182, 260
asymptomatic 180, 181
complete 146
expectant management of 180
magnetic resonance imaging for 148
marginal 146
partial 146
spectrum 267
symptomatic 181
true 147, 147f
thickened heterogeneous 149f
Placental abnormality 234
Placental abruption 144, 162t, 249
location of 144
types of 145f
ultrasound diagnosis of 144
Placental adherence 86
Placental cord insertion 152f
Placental infarction 150
Placental migration 147
Placental myometrial interface, normal 149f
Placental polyp 225
Placental site trophoblastic tumor 119
Placental tissue 197, 199
Placentation, abnormal 84, 107, 117, 132, 136
Plasma protein 66
A, pregnancy associated 164
Plasminogen activator inhibitor type 2 249
Plaster to fix cannula 5
Plastic bag, ordinary 4
Platelet 58, 67, 71, 200, 274
abnormalities of 253
concentrate 66
count 200, 257, 269, 274
deficits 67
disorders, acquired 254
function, inherited disorders of 253
rich concentrate 67
rich plasma 67
transfusion 272, 281
Pneumonia 109
Point-of-care testing 270, 283
Polyglycolic acid 157
Polyhydramnios 143, 194
sudden decompression in 162
Polyvinyl alcohol 233
Poor health infrastructure 3
Postabortion
hemorrhage 131
causes of 132
management for 134, 134t
syndrome 133
treatment of hemorrhage in 101t
triad 133
Postnatal care 168
Postpartum hemorrhage 3, 12, 18, 24, 26f, 31, 40, 42, 50, 155, 157, 193-195, 201, 203, 210, 218, 231, 231t, 239, 259, 276
antenatal risk factors for 204t
anticipate 46
audit of 14
box 5t
causes of 3
diagnosis of 45
drills 4
endovascular management of 230
identification of 218
intrapartum risk factors for 205t
management of 4, 24, 64, 156, 195, 196, 208, 239
massive 6
morbidity, prevent 46
mortality, prevent 46
pharmacological management of 199t
prevention of 219
previous 194
risk factors for 194t
secondary 226t
risk of 3
secondary 9, 52, 225, 235, 236f
standards for 18t
stepwise management of 195
structured audit in 13
Postpartum intrauterine contraceptive device 24
Postpartum maternal complications 169
Postpartum period 174
Postvaginal delivery 206
Potassium chloride 110, 112, 126
injection of 91
Practical skills 4
Preconceptional health and care 42
Pre-eclampsia 115, 163, 165, 194, 255, 266
Pregnancy 35, 37 38, 40, 75, 249
abdominal 87, 91
angular 113, 113t, 114
complications, management of 79
hemostatic changes in normal 249
medical termination of 98
physiology in 75
preterm 44
second trimester termination of 101
specific disseminated intravascular coagulation scoring system 270t
Pregnant women 78
Premature ovarian aging 110
Primary hemostasis 81
Primigravida 44
Progesterone therapy 116
Prostaglandin 5, 98
F2 alpha 228
Prothrombin complex 65
concentrates 273
Prothrombin deficiency 253
Prothrombin time 166, 200, 207, 256, 257, 269, 274, 280
Pseudomonas 102
Pulmonary edema 216
Pulmonology 37
Pulse 61
oximetry 280
pressure 54
rate 54, 197, 201
monitoring 6
Q
Quick in quick out
policy 261
technique 263
R
Radiation exposure 237
Random donor platelets 281
Randomized controlled trial 240, 273
Red blood cell 17, 61, 66, 186, 271, 282
packed 53
radioactive tagging of 61
Red cell
concentrates 280
transfusions 67
Referral transportation 8
Regular hospital care 37
Renal curve 233
Renal failure 166
acute 39
Renal function 88
tests 167
Reproductive function 121
Respiratory
acidosis 56
alkalosis 56
center 78
physiology 78
rate 54, 197, 201
Resuscitation 227
Resuscitative hysterotomy 79
Retained placenta 65, 194, 199
Retained placental tissue 225
ultrasound examination for 227
Retained tissue 52, 99, 132, 137
Retroplacental collection 166
Rh-negative platelets 68
Ringer lactate 5
Robertson uterine artery 233
Rotational thromboelastometry 270
Royal College of Obstetricians and Gynaecologists 156, 203, 210, 221
Rubin's criteria 124
Rudimentary horn pregnancy, right 94
Rupture uterus 40
diagnosis of 174
S
Safe labor ward 29
Safety
maternity dashboard for 27
signage for 26
staffing for 25
training for 25
Salpingectomy 89, 90
Salpingostomy 89
incision 94f
Sampson's artery 261
Scar
previous 99
tenderness 173
Scarred uterus, rupture of 171
Scissors, pair of 5
Secretory disorders 254
Sepsis 40, 194, 260, 266, 268
causes of 102
Septic abortion 97, 102
clinical features 102
complications 103
investigations 103
management 103
mode of infection 102
pathology 102
phases of 103f
prevention 103
Serum
beta-human chorionic gonadotropin 227
electrolytes 103
fibrinogen 167
vacutainers, plain sample for 55f
Shift handovers serve 26
Shock 165, 278, 278t
acute 278
clinical 201b
compensated 278
decompensated 278
hemorrhagic 54, 54t, 75
hypovolemic 54
index 42, 279, 279t
management of 55
stages of 46t, 277, 278t
subacute 278
types of 277b
Short umbilical cord 163
Shoulder dystocia 28
Single donor platelets 281
Skilled birth attendant 38
Skin 267
Sliding off technique 261
Sliding sign 108
Special hemostatic measures 113
Specialized care units, types of 37
Speculums, large 5
Spontaneous circulation, return of 79
Staff lounge 23
Standard operating procedure 31, 32
Staphylococcus 102
aureus 102
Sterile gloves 5
Sterile trays 22
Stomatitis 109
Subchorionic abruption, ultrasonic image of 144f
Subchorionic hematoma 115, 116, 166
Suburethral nodule 121, 121f
Suction apparatus, blood collected in 63f
Suction tamponade device 243
Sudden severe sharp pain 165
Supralevator hematoma 214, 223
Surgery, laparoscopic 111
Surgical challenges 154
Surgical compression suture 82f
Surgical intervention 280
Syntometrine 49
Systemic methotrexate 109
T
T2 dark intraplacental bands 148
Tachycardia 165, 279
Tamponade 208, 243f
Tazobactam 104
Tears, management of 220
Tenderness over uterus, mild 165
Testing, time of 56
Therapeutic management 114
Thrombin 3, 197
time 280
Thrombocytopenia 255
destructive 255
gestational 254, 258
Thromboelastogram 257, 270
Thromboelastograph 52f
signature waveform 52f
Thromboelastography 270, 283
Thromboelastometry studies 270
Thromboembolism 242
Thrombophilia 163
Thrombosis, factors affecting 78f
Thrombotic microangiopathies 255
Thrombotic thrombocytopenic purpura 255
Tissue 3, 75, 197
hypoxia 159
perfusion 61, 198
Tone 3
Tools, standardization of 14
Total blood volume 277
Total hysterectomy 215
Tranexamic acid 157, 207, 228, 241
role of 6, 228
Transabdominal excision 92
Transabdominal ultrasonography 181
Transcatheter arterial embolization 237
Transfusion
complications 70
reactions
acute 70
chronic 70
common 70
Transvaginal route 110
Transvaginal sonography 147, 154, 181
Transvaginal ultrasound 126
Trauma 3, 143, 150, 162, 163, 197, 233
history of 143
Traumatic cervical injuries 98
Traumatic postpartum hemorrhage 9, 218
causes of 218
management of 220
Traumatic shock 277
pathophysiology of 277
Treponema pallidum 69
Trigger, removal of 271
Triple P procedure 243
Trisodium citrate 56
Trophoblastic hyperplasia 119
Tubal ectopic pregnancy 87, 111
ruptured right 93f
unruptured right 94f
Tubal rupture 87
risk of 88
Tubes and ovary, blood supply of 83f
Twin
pregnancy 119
with hydatidiform mole 119
Tying uterine vessels 158
Typical diseases 268
U
Ultrasonography 143, 151, 166, 173
high-resolution 262
Ultrasound imaging 180
Uninterrupted power supply 23
Unscarred uterus, rupture of 171, 172
Upper vaginal segment, arteriography of 83f, 84f
Urea 6
Urinary tract 175
Urine
output 54
pregnancy test 93, 94
routine 167
Urobag 5
Uterine 83
arterial embolization 230, 237
technique of 233
arteriovenous malformation 226, 235
atony 65, 80, 132, 135, 233
body 84
bulging 148
cavity 94, 120
contour, abnormal 173
contraction 81f
curettage 226
embolization procedure 84f
evacuation 228
infection 225
injury 101
lesions 225
massage 7
muscle, circular 80f
packing 5, 7, 210
pathology 225
perforation 133, 137
position 133
rudimentary horn, right 94f
scar rupture, repair of previous 175f
segments 83f
septum 163
sound 137
surgery 226
tetany 165
Uterine artery 214f, 232
angiogram 234f
branches of 234f, 235f
embolization 101, 105, 109, 110, 126, 136, 209, 210
ligation, bilateral 8
right 83, 84
Uterine myometrium 90
defective 92
Uterine rupture 65, 171, 175, 177, 260
clinical presentation of 173
complete 171
incomplete 171
prediction of 172
prevention of 176
previous 172
Uterine tamponade 50, 228
internal 242
Uterotonic drugs 4, 100, 228
administration of 207t
storage of 6
Uterotonics 4
Uterus 44
anteroinferior wall of 236f
arteriography of 83f, 84f
blood supply of 83f
complete rupture of 171f
conserving 243
contraction of 165
hour glass appearance of 124f
inversion of 199
perforation of 120, 120f, 121
puerperal inversion of 225
rupture of 143, 171, 197
woody 165
V
Vacuum aspiration, manual 98, 134
Vagina 84
blood supply of 83f
Vaginal artery
middle
left 83
right 83
upper left 84
Vaginal births 63
Vaginal bleeding 109, 173
mild 165
severe 235f
Vaginal delivery 31, 168, 240
Vaginal lacerations 197
Vaginal metastasis 121
Vaginal packing 221
Vaginal tear
repair 221
superficial 221
Vasa previa 143, 151, 152f
Vascular coagulation 110
Vascular ligation 8
Vasopressin 57, 272
Vasopressors 58
Velamentous cord 152f
Ventouse-related lacerations 222
Vincristine 120
Visual assessment 61, 64
Vital parameters monitored 138
Volume replacement 67
von Willebrand's disease 226, 250
von Willebrand's factor 250
Vulvovaginal infections 143
W
Wash area 23
Waste management 21
Wedge resection 91
Whole blood 66
transfusion 52
Workflow design for labor, delivery and recovery 22f
World Health Organization 193, 210, 239
World Maternal Antifibrinolytic Trial 241
Y
Young-laplace equation 81f
×
Chapter Notes

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Obstetric Hemorrhage Evidence-based Management and Recent Advances
Obstetric Hemorrhage Evidence-based Management and Recent Advances
Editors Sheela V Mane MBBS MD FICOG FICMCH Former Professor Department of Obstetrics and Gynecology DNB Faculty KC General Hospital, Bengaluru Organizing Secretary, AICOG, 2019 Past President, BSOG Vice President, FOGSI, 2014 National PPH Workshop Convenor, FOGSI Chairperson Safe Motherhood Committee, FOGSI, 2008-11 Senior Consultant Anugraha Nursing Home Bengaluru, Karnataka, India Shobha N Gudi MD DNB FICOG CIMP Professor and Head Department of Obstetrics and Gynecology St Philomena's Hospital, Bengaluru Consultant Manipal Sagar and Excel Care Hospitals Bengaluru, Karnataka, India Chairperson, Family Welfare Committee, FPGSI FOGSI, 2019-21 Past President, BSOG Secretary, BMS, 2018-20 Board Member, FPAI Distinguished NBE Teacher Peer Reviewer, JOGI Co-Editor Priyanka Dilip Kumar MBBS DNB Obstetrician and Gynecologist Reproductive Medicine Specialist Department of Obstetrics and Gynecology Anugraha Nursing Home Bengaluru, Karnataka, India Forewords CN Purandare Nandita Palshetkar Sabaratnam Arulkumaran
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Obstetric Hemorrhage: Evidence-based Management and Recent Advances
First Edition: 2020
9789352708987
Printed at
This work is dedicated to my beloved parents, late Dr VU Mane and Mrs Bharati Devi Mane, whose blessings have always guided me, my wonderful husband Dr V Dilip Kumar and my dear children Drs Priyanka and Anup, my son-in-law Dr Vijay Korvi and my little fairy grand-daughter Avani.
— Sheela V Mane
This work is dedicated to my beloved parents, late Prof S Ranganna and Mrs Ahalya Bai, their sacrifice and affection has made me what I am today, my dear husband Dr Narayan S Gudi who is a constant source of inspiration and my charming son Varun.
—Shobha N Gudi
We dedicate this manuscript to all those mothers who are true martyrs: they lost their precious lives in order to birth new lives.
Contributors Foreword
Obstetric hemorrhage is a very debated and discussed subject. No matter how much we are prepared, it falls short of optimal care to reduce the attendant maternal mortality and morbidity. Such as the complex nature of obstetric hemorrhage and the varied way in which it can complicate a case.
This book encompasses all aspects of obstetric hemorrhage. The topics are exhaustive and have been written by the experts in the field. The book also covers topics of blood transfusion and interventional radiology. All the chapters have been written keeping in mind the current concepts and recent developments.
I would like to congratulate the editors Dr Sheela V Mane and Dr Shobha N Gudi on building up this novel idea and putting it into perspective. This book will be a very useful guide for students and clinicians.
CN Purandare
MD MAO(IRL) DO RCPI(DUB) DGO DFP
FRCOG(UK) FRCPI(IRL) FACOG(USA) FICOG FICMCH FAMS PGD MLS(LAW)
President, FIGO 2015-18
President, FOGSI 2009-10
Senior Consultant Obstetrician and Gynecologist
Dean of the Indian College of Obstetricians and Gynecologists
Emeritus Editor for the Journal of Obstetrics and Gynecology of India
Foreword
It gives me great pleasure to write the foreword for the book on Obstetric Hemorrhage: Evidence-based Management and Recent Advances.
I think the editors Dr Sheela V Mane and Dr Shobha N Gudi have done a wonderful job in conceptualizing the contents and selecting the authors. We at Federation of Obstetric and Gynaecological Societies of India (FOGSI) are working toward women empowerment. In fact the theme of my presidential year ‘We for Stree’ is well supported and enriched by this endeavor.
The responsibility lies on each and every obstetrician to act fast in cases of obstetric hemorrhage and prevent mortality and further morbidity. There are excellent directives in the book for capacity building and skill enhancement. We hope that the book will reach all the members of our fraternity and that their patients will greatly benefit from it.
Nandita Palshetkar
MBBS MD FCPS FICOG FRCOG (HON)
President, FOGSI 2019
Director, IVF and Infertility at Fortis Bloom IVF Center
Professor, Department of Obstetrics and Gynecology
DY Patil Medical College, Navi Mumbai, Maharashtra, India
Teacher, FNB Course at Lilavathi Hospital
Foreword
Obstetric hemorrhage contributes to 30% of child birth related to 300,000 global maternal mortalities. Morality is the tip of the iceberg whilst morbidity is much greater. From recent studies, it is clear that the incidence and severity of obstetric hemorrhage is on the increase. Understanding the various etiologies, basic pathophysiology, increasing evidence-based practice and recent advances in management of obstetric hemorrhage provide us the possibility to devise the best prevention and management strategies.
The editors Dr Sheela V Mane and Dr Shobha N Gudi are well-known for their passionate commitment to reduce maternal mortality due to postpartum hemorrhage (PPH). For decades, they have been advocates, teachers and trainers to reduce and if possible eliminate maternal deaths due to PPH. Now they deserve our congratulations for bringing out the excellent book ‘Obstetric Hemorrhage: Evidence-based Management and Recent Advances’ which covers bleeding from early pregnancy like that related to termination of pregnancies and ectopic pregnancy to antepartum hemorrhage due to abruption and placenta previa to PPH due to various causes.
The book is well laid out into five sections. The chapters in the different sections cover the technical, nontechnical and organizational skills and requirements needed to ‘eliminate’ morbidity and mortality related to obstetric hemorrhage. The authors are well-renowned for expertise in the area in which they have contributed the chapter. I would encourage practicing clinicians and researches to read the book and recommend libraries and delivery units to have a copy of the book for quick reference.
Yours sincerely,
Sabaratnam Arulkumaran PhD DSc FRCS FRCOG
Past President, RCOG 2007-10
Past President, BMA 2013-14
Past President, FIGO 2012-15
Preface
Mothers continue to die due to preventable causes because societies are yet to realize that their lives are worth saving. Today we are in the era of preventive obstetrics, where there is no role of maternal mortality or major morbidity due to preventable causes like obstetric hemorrhage. Worldwide, hemorrhage remains a major cause of maternal death—it is estimated that between one-quarter and a half of preventable maternal deaths are secondary to hemorrhage especially in the developing world. Treatment is delayed by failure to recognize major obstetric hemorrhage. The physiological changes of normal pregnancy mask the clinical presentation of hypovolemia and delays the presentation. The thought for initiating contributions to compile this book has been the overwhelming concern among health providers that all obstetricians do not have adequate skills for control of hemorrhage, transfer of critically ill mothers are suboptimal and infrastructural deficiencies have a profound impact on the outcome for the mother and the fetus.
We conceptualized this book 18 months back and now finally at the threshold of All India Congress of Obstetrics and Gynaecology (AICOG) 2019, we find ourselves ready to showcase the sincere efforts of the contributors who have not only tirelessly worked to submit the manuscripts in time but also shared their invaluable experience. We thank them sincerely for accepting their assignments and writing such wonderful chapters.
We thank our families, peers and friends for being there for us throughout the editorial and working process for this book lending us their unconditional moral support.
We are convinced this book will help consultants, postgraduates and obstetric intensivists in updating their knowledge and skills.
Sheela V Mane
Shobha N Gudi
Acknowledgments
We are deeply indebted to all our contributors for dedicating their time and sharing their experience for this book. We thank the hospital authorities who provided us the clinical material and infrastructure and the patients who provided us the information needed to write these texts.
We would like to thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr MS Mani (Group President), Ms Chetna Malhotra Vohra (Associate Director—Content Strategy), Ms Pooja Bhandari (Production Head) and Nikita Chauhan (Senior Development Editor) of Jaypee Brothers Medical Publishers, New Delhi, India, for facilitating the editorial process.