Fellowship trial exam Question 26

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Presentation transcript:

Fellowship trial exam Question 26 Monash Health June 2016 Parya Fadavi, ED Physician , Casey Hospital

List five potential risk factor for post part haemorrhage. (5 marks) Question 26: 35 y/o woman has just delivered a term infant in your resuscitation room after presenting with imminent labour.The child is stable. The mother is pale and semi-responsive.Her heart rate is 120 and BP 75/35.There is ongoing significant per vaginal bleeding. List five potential risk factor for post part haemorrhage. (5 marks) 1-Retained placenta 2-grand multiparty 3-antepartum haemorrhage 4-over distension of uterus 5-large placenta associated with multiple pregnancy 6-Past hx of PPH/ hemorrhagic disorder

continues….. 7-Fibroid uterus 8-precipitate labour 9-Induced labour 10-Prolonged labour 11-Chorioamnionitis 12-Tocolytic agent, inhalation anesthetics.

Common mistakes: Describing the causes of PPH not the risk factors!!!

2-List in escalating order , 5 management steps to control the PPH 2-List in escalating order , 5 management steps to control the PPH. (5 marks) 1-Robbing the uterus 2-Oxytocin 5 Units IV ( or 10 units), follows by infusion 40 units in 1000 ml, normal saline, 250 ml/hour( misoprostol PR, Ergometrin, PGF2alpha) 3-Delivering placenta if has not been delivered 4-Repairing the lacerations if exists. 5-Surgical management

common mistakes: answers all over the place! Massive transfusion oxytocin dose

3-List the key components of massive transfusion protocol, including appropriate ration of blood products(6 marks) 1-Early notification of blood bank and haematologist. 2-usually if patient needs more that 4 units of RBC/ or ongoing heavy bleeding anticipated, Ratio RBC:FFP:PLT 1:1:1 3-Avoid hypothermia—-warm product if possible (T>35) 4-Avoid hypocalcemia( ionised Ca>1.1 mmol/L) 5-Avoid academia PH>7.2 6-prevent/correct coagulopathy( INR<=1.5, PLT>50,Fibrinogen>1 g/l) cryoprecipitate,

General result based on raw mark