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Consider tone, tissue, trauma, and thrombin when assessing postpartum hemorrhage risk. (Four T's).
AMELIA ISLAND, FLA. -- Think of the four T's-tone, tissue, trauma, and thrombin-in assessing a patient's risk for postpartum hemorrhage and treating it when it occurs, Dr. Hugh W Randall Jr. said during an ob.gyn. update that was sponsored by Emory University.
The presence of any of the following indicates a high risk of postpartum hemorrhage, said Dr. Randall, who is chief of the gynecology and obstetrics service at Grady Memorial Hospital in Atlanta:
* Tone. Abnormalities of uterine contraction can result from several etiologic processes: overdistended uterus; uterine muscle exhaustion resulting from high parity, rapid labor, or prolonged labor; intraamniotic infection from fever or prolonged rupture of the membranes; and functional distortions of the uterus from leiomyomata, placenta previa, and other uterine anomalies.
* Tissue. Retained products of conception heighten a woman's risk for postpartum hemorrhage, according to Dr. Randall.
Look for an incomplete placenta at delivery, previous uterine surgery high parity, or an abnormal placenta on ultrasound. The atonic uterus accounts for 80%-90% of postpartum hemorrhages and results from retained blood clots.
* Trauma. Genital tract trauma includes lacerations of the cervix, vagina, or perineum; extensions at cesarean section; uterine rupture; and uterine inversion, Dr. Randall said.
* Thrombin. Be aware of any preexisting ...
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