Anesthesia for the patient with peripartum hemorrhage
- Jill M Mhyre, MD
Jill M Mhyre, MD
- Associate Professor of Anesthesiology
- University of Arkansas for Medical Sciences
- Faiza A Khan, MD
Faiza A Khan, MD
- Assistant Professor
- University of Arkansas for Medical Science
Peripartum hemorrhage is a major cause of maternal morbidity and mortality. Effective management requires a multidisciplinary, structured approach, with recognition that obstetric hemorrhage can rapidly become life threatening. This topic will discuss the anesthetic management of patients with peripartum hemorrhage or conditions that increase the risk of such hemorrhage.
Obstetric management of these patients and the approach to the management of postpartum hemorrhage (PPH) are discussed in detail separately. (See "Overview of postpartum hemorrhage" and "Postpartum hemorrhage: Medical and minimally invasive management" and "Postpartum hemorrhage: Management approaches requiring laparotomy" and "Placental abruption: Management" and "Management of placenta previa" and "Velamentous umbilical cord insertion and vasa previa" and "Uterine rupture after previous cesarean delivery" and "Peripartum hysterectomy for management of hemorrhage".)
Antenatal anesthesia consultation should be arranged for patients at high risk of peripartum hemorrhage and those for whom blood product preparation or transfusion may be complicated. (See "Overview of postpartum hemorrhage", section on 'Management of risk'.)
All obstetric patients should be evaluated for potential difficulty with airway management to create a plan for safe airway management in case general anesthesia is necessary. (See "Airway management of the pregnant patient at delivery", section on 'Identify patients with a difficult airway'.)
In addition to the usual medical and prenatal history, and anesthesia-directed physical examination, the following considerations should be addressed antenatally whenever time permits.
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- PREANESTHESIA EVALUATION
- GENERAL CONCERNS
- ANTEPARTUM HEMORRHAGE
- Placenta previa
- Placental abruption
- Uterine rupture
- Vasa previa
- POSTPARTUM HEMORRHAGE
- Multidisciplinary care and coordination
- Anesthesia for postpartum hemorrhage
- - Neuraxial anesthesia for postpartum hemorrhage
- - Moderate sedation/analgesia for postpartum hemorrhage
- - Uterine relaxation
- - General anesthesia for PPH
- Induction of anesthesia with postpartum hemorrhage
- Maintenance of anesthesia for postpartum hemorrhage
- Postoperative care after PPH
- SCHEDULED CESAREAN HYSTERECTOMY
- Preparation for transfusion
- Venous access
- Choice of anesthetic technique
- - Anesthesia for arterial catheterization for embolization
- Management of anesthesia for cesarean hysterectomy
- - General anesthesia
- - Neuraxial anesthesia
- - Uterotonic drugs
- - Postoperative analgesia
- SYSTEMS LEARNING FOR OBSTETRIC HEMORRHAGE
- SUMMARY AND RECOMMENDATIONS