0071643192.pdf

OBSTETRICS AND GYNECOLOGY

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CAUSES

The causes of postpartum hemorrhage include:

■ Uterine atony (most common)

■ Uterine rupture

■ Laceration of the lower genital tract

■ Retained placenta

■ Uterine inversion and coagulopathy

■ Late hemorrhage can be due to infection, retained placenta (most com-

mon), uterine inversion, coagulopathy, or sloughing of the placental site

eschar.

EXAM/DIAGNOSIS

■ Physical exam is the cornerstone to the diagnosis.

■ An enlarged and “boggy” uterus is seen with uterine atony.

■ A vaginal mass is seen with uterine inversion.

■ Vaginal bleeding despite good uterine tone and size is likely due to retained

products.

TREATMENT

■ Depends on suspected underlying cause.

■ Treat uterine atony with oxytocin and vigorous bimanual massage.

■ Stabilize with crystalloid fluids or packed RBCs if needed.

■ Repair lacerations.

INFECTIONS IN PREGNANCY

Urinary Tract Infections

Asymptomatic bacteriuria can be seen in up to 10% of patients. E. coliis respon-

sible for most infections.

TREATMENT

■ Cystitis along with asymptomatic bacteriuria should be treated with anti-

biotics to prevent preterm labor/delivery.

■ Cephalosporins and nitrofurantoin are recommended antibiotics.

■ Floroquinolones and trimethoprim/sulfamethoxazole are contraindicated

secondary to teratogenic effects.

Appendicitis

SYMPTOMS/EXAM

■ The presentation of appendicitis during early pregnancy may be similar to

that in the nonpregnant patient.

■ Later in pregnancy, the enlarging uterus may shift the appendix into the right

upper quadrant so the presenting complaint may be RUQ pain, although the

most common presentation is still RLQ pain.

Appendicitis is the most

common nonobstetrical

surgical emergency in

pregnancy.