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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Stages of obstetric hemorrhage

Stages of obstetric hemorrhage
Stage Definition Criteria
Stage 0 Observation period following delivery of the neonate for signs of abnormal bleeding*
  • All births
Stage 1 First sign of abnormal bleeding
  • Blood loss >500 mL VD or >1000 mL CD and <1500 mL
  • Brisk bleeding, large gush, large or multiple clots
  • Boggy uterus
  • Vital sign change >15 percent; or heart rate ≥110 beats/min, BP ≤85/45 mmHg, or O2 saturation <95 percent
Stage 2 Bleeding that continues despite initial bedside interventions
  • Continued bleeding or unstable VS, or symptomatic AND
  • Total blood loss <1500 mL
Stage 3 Major postpartum hemorrhage
  • Cumulative blood loss ≥1500 mL or
  • >2 units packed red cells transfused or
  • Coagulopathy suspected
Stage 4 Catastrophic postpartum hemorrhage
  • Hypovolemic shock or
  • Disseminated intravascular coagulopathy confirmed or
  • Amniotic fluid embolism suspected
There is no national consensus on the definitions of the stages of obstetric hemorrhage. However, there is consensus that clinicians should create common terminology at the institutional level, and that care providers should communicate and manage hemorrhage in terms of stages. This table shows an example of such a stage-based approach to obstetric hemorrhage, with criteria for assigning the various stages.
VD: vaginal delivery; CD: cesarean delivery; BP: blood pressure; O2: oxygen; VS: vital signs.
* The Association of Women's Health Obstetric and Neonatal Nurses recommends a period of two hours following vaginal or cesarean birth to observe for abnormal postpartum bleeding.[1]
References:
  1. Perioperative care of the pregnant woman. Evidence-based clinical practice guideline. Association of Women's Health Obstetric, and Neonatal Nurses, 2011.
Modified from: Lyndon A, Lagrew D, Shields L, et al. Improving Health Care Response to Obstetric Hemorrhage (California Maternal Quality Care Collaborative Toolkit to Transform Maternity Care). Developed under contract #11-10006 with the California Department of Public Health; Maternal, Child and Adolescent Health Division; Published by the California Maternal Quality Care Collaborative, 2015. Available at: www.cmqcc.org (accessed on November 18, 2016).
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