June 2021

How to Manage Postpartum Hemorrhage

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Postpartum hemorrhage is defined as ≥1000mL of blood loss irrespective of the delivery route, with associated shock. Remember the four “T’s”: tone (uterine atony), trauma (lacerations, uterine rupture), tissue (retained placenta, clots) and thrombin (coagulopathies). Manage the ABCs (especially two large bore IV’s for massive transfusion) and tailor treatment to the specific cause. Recommendations for balanced transfusion are derived from the trauma literature, but it is important to administer cryoprecipitate earlier to maintain a higher fibrinogen level (at term the normal level is >350mg/dL).

How to Prevent Post-LP Headaches

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Risk for post-LP headache can be lessened by using atraumatic non-cutting needles, which, contrary to popular belief, are not more difficult to use than traditional cutting needles. Utilizing the lateral decubitus position, a higher intervertebral space, and orienting the needle bevel parallel to the spinal axis may also decrease risk. Other common recommendations, including IV fluids, caffeine, and bed rest are unlikely to help.

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