Peripartum life-threatening haemorrhage - 2018

00:00

You are called as an anaesthetist to the delivery room to the 30 years old woman in labour (V-gravida, III-para). The delivery was physiological in term, performed in epidural analgesia, common blood loss during the birth (I. stage of labour 8 hours, II. stage of labour 10 minutes), the boy was delivered (3950 g, 52 cm, Apgar score 8-10-10). At the beginning of third stage of labour strong bleeding from genitals appears, there is a blood loss of 500 mL within 5 minutes. Shortly after the delivery of the placenta, the patient is conscious, pale, tachycardic, free of signs of respiratory insufficiency. What will be your next step?

Give oxygen via face mask, obtain 2 peripheral vein accesses and administer 4-6 TU of FFP, monitor basic life functions.

Wrong answer

Administration of 4-6 TU FFP without obvious coagulation disorder is not indicated.


Back

Obtain 2 peripheral vein accesses, give oxygen via face mask, monitor vital functions (in case of loss of consciousness, intubate in time).

Correct answer

For each pre-collapse state are external vein accesses, giving oxygen and basic life functions monitoring priority.


Continue

Oxygen therapy is not indicated, obtain 2 peripheral vein accesses, and monitor basic life functions.

Wrong answer

Every pre-shock state requires oxygen therapy.


Back

Always intubate the patient and give oxygen, obtain 2 peripheral vein accesses and monitor basic life functions.

Wrong answer

The patient is at the moment conscious and doesn’t have any signs of respiratory insufficiency. Currently, there is no indication for intubation (indicated once GCS drops below 8).


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Help

ACT – activated clotting time TT – trombin time FBG – fibrinogen TEG – trombelastogram FFP – fresh frozen plasma AT III – antithrombin III GCS – Glasgow Coma Scale DIC – disseminated intravascular coagulation TU – transfusion unit mL - mililiter IV - intravenous IM - intramuskular×
 
RR

24 bpm

HR

111 bpm

SpO2

88 %

BP

85/58 mmHg

ECG

not available

 

Gly

not available

ABG

not available

CBC

not available

biochemistry

not available