1. Fluid Management of Maternal Hemorrhage Dr.Hantoushzadeh

2. 2 Maternal Mortality -All pregnancies- EtiologyM. Hemorrhage28.7% Embolism19.7% P.I.H.17.6% Infection13.1% Cardiomyopathy5.6% Anesthesia complic2.5% Others12.7%

3. 3 1- Identify risk - Placenta previa/accreta -Anticoagulation Rx -Coagulopathy -Over distended uterus -Grand multiparity -Abnormal labor pattern -Chorioamnionitis -Large myomas -Previous history of PPH Maternal Mortality - Obstetrical Hemorrhage -

4. 4 O 2 Delivery = C.O. x Sa O 2 x Hb% Fluid management  Oxygenation Transfusion Maintain aerobic metabolism Hemorrhagic Shock - Management - CO = cardiac output SaO2 = Systemic arterial oxygen saturation

5. 5 ClassBlood Loss Volume Deficit SpxRx I < 1000 cc15% Orthostatic tachycardia Crystalloid II 1001-150015-25% Incr. HR, orthostasis, mental Decr cap refill Crystalloid, III 1501-250025-40% Incr HR, RR Decr BP, Oliguria Crystalloid Colloid, RBCs IV > 2500 > 40% Obtunded Oliguria/anuria CV collapse RBC, Crystalloid, Colloid Managing blood loss by hemorrhage classification

6. 6 Blood Components ProductVolumeComponents Indication/ Utility Whole blood450-500 ccHct. 36-44%1u =1g/dl Hb PRBC200-250 ccHct. 70-80%1u = 1g/dl Hb Platelets30-50ccPlatelets WBC Ag1u = 5000uL FFP100cc Fibrinogen, clotting factors PT, PTT> 1.5 x nl, INR > 1.6 Cryo- precipitate 50-75cc Factor 8c, Von Willebrand’s factor, Fibrinogen Fibrinogen replacement

7. Factor Replacement Therapy VWF Hemophilia Acquired Inhibitors Plasmapheresis

8. Platlets transfusion ITP Acute Fatty Liver HELP Sever Preeclampsia IUFD Placental Abruption