Etiology and Management of Hemorrhage (Includes Accreta)

Irene A. Stafford, Karin A. Fox, Michael A. Belfort, Gary A. Dildy

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Postpartum hemorrhage (PPH) was determined by visual estimates, which have largely been replaced by gravimetric quantitative blood loss (QBL) with improved sensitivity and specificity. The QBL method involves weighing sponges and measuring fluid in suction canisters. Massive hemorrhage may also result from surgical causes in pregnant or postpartum women. Placental abruption is the premature separation of a normally situated placenta, which may be partial or complete. Uterine rupture may occur in an unscarred uterus, at the site of a previous uterine scar from a cesarean section, or a full-thickness incision secondary to gynecologic surgery. The most common treatment method for placenta accreta spectrum remains a cesarean hysterectomy. Uterine inversion often presents with a profound shock of neurogenic and hemorrhagic origin. Consumptive and dilutional coagulopathies secondary to extensive blood loss and crystalloid replacement are PPH’s most common bleeding disorders. Uterine devascularization is a surgical technique for PPH due to atony, placenta previa, and trauma.

Original languageEnglish (US)
Title of host publicationCritical Care Obstetrics, Seventh Edition
Publisherwiley
Pages627-663
Number of pages37
ISBN (Electronic)9781119820260
ISBN (Print)9781119820246
DOIs
StatePublished - Jan 1 2024
Externally publishedYes

Keywords

  • placenta accreta spectrum
  • placental abruption
  • postpartum hemorrhage
  • surgical management
  • uterine atony
  • uterine inversion
  • uterine rupture

ASJC Scopus subject areas

  • General Medicine

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