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CVS alterations during pregnancy
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Refer to the following table.
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Table: CVS alterations during pregnancy
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Assessment of blood loss in the Parturient
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Clinical signs of blood loss in the parturient are unreliable
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Use the following table as a rough guide.
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Table: Assessment of blood loss in the Parturient
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| | | | None, palpitations, dizziness, tachycardia
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| | | Postural drop in BP, tachycardia, weakness, sweating
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| | | Hypotension (80-100mmHg), tachycardia, restlessness, oliguria, pallor
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| | | Hypotension (<80mmHg systolic), tachycardia >120 bpm, altered conscious state/collapse, anuria
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- Aortocaval compression may cause hypotension in the absence of hypovolemia.
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- Remember concealed blood loss.
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- Hypotension is a late sign in this population group.
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Management of major blood loss in the Parturient
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1. Notify the following:
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- theatre, midwifery and ancillary staff
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2. Give oxygen and ensure aortocaval compression is relieved.
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3. Secure adequate IV access - at least 16G x 2. Remember rapid infusion catheters (RIC) that use Seldinger technique via 18G cannula.
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4. Fluid replacement
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- Give Hartmanns 1000 mL stat via each cannula.
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- If blood is not immediately available, give Gelofusine 500mL stat.
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- In major haemorrhage give blood. If cross matched blood is not available ring blood bank and ask for the emergency blood release pack (up to 5 units O neg, kell neg PRBC). Do not delay while waiting for a cross match: if the patient's blood group is known and a current sample is in the blood bank, give group specific blood. If blood has not been sent for a cross match send a sample prior to giving O negative blood but do not wait for the result.
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5. Use a Level 1 rapid fluid warmer / infusor (corridor outside theatre 4). Do not insert bags containing air, e.g. haemaccel.
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6. Monitor coagulation indices.
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- Dilutional coagulopathy and thrombocytopenia common after the replacement of one circulating volume.
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- Early coagulopathy may be due to underlying DIC, especially if placental abruption.
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- Replacement of clotting factors should follow haematological advice or adherence to ASA transfusion guidelines
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7. Transfer - most patients will require transfer to either an ICU or high dependency unit.
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Royal Women's Hospital Clinical Practice Guidelines (CPGs) are intended to provide guidance to health care professionals, based on a thorough evaluation of research evidence, on the practical assessment and management of specific clinical issues or situations. The guidelines allow some flexibility on the part of the health care professional based on the needs of the specific patient for whom they are caring.
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