Monday, February 16, 2009
Humdinger of a Hemorrhage
I had a heck of a postpartum hemorrhage today. This patient came in and had a great natural labor and birth (ok,well I had a body dystocia that lasted almost two minutes) followed by a waterfall after the spontaneous, intact placenta. I threw everything at her including the dreaded hemabate (the nurse was thanking me for ordering lomotil as well). A resident popped in at this point to offer help. I'm looking at him and thinking "well, jump right in". He asked me if I had given cytotec. Um, yeah, about four drugs ago! Anyway, she's ok two liters less but ok!
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3 comments:
What did her postpartum H&H get to (and what was it before)?
We had a pretty good one not too long ago, too... with the methergine, hemabate, and cyto. I don't know what her H&H got to. This one wasn't so much a flood right at delivery but unabating over time, had to call the MD back-type. She ended up going back in and stitching more, so I guess one of the above eventually did the trick. I don't know what her h&h got to.
That was the same day I was helping my sweet little amphetamine-taker, who was apparently not happy to be away from her amphetamines, who had platelets of 54 and 46 (no other sx, I think she was just thromobcytopenic for???), hence no epidural, who supposedly didn't want one anyway, who LITERALLY screamed at the top of her lungs the entire day until she delivered shortly after hemorrhage girl #1. I work in L&D, I don't say "screamed at the top of her lungs ALL day" lightly, and this was even after stadol and a *morphine PCA*. I can't believe she still has vocal cords.
Good times.
OUCH-2 liters? Yeah, gotta love the hemabate and resulting explosions, but hey, whatever works! :)
Her hemoglobin prior was around 12.4. The next morning she was 8.4
So that's pretty consistent with a 2 liter loss. And she was feeling fine - totally asymptomatic!
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