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Postpartum Hemorrhage: What Every Pregnant Woman Should Know

Having a baby can be a beautiful thing until something goes wrong. The tragedy is that many high-risk conditions can be managed appropriately if the patient is cooperative and the healthcare provider is competent and well trained. Unfortunately, almost 600 pregnant women die in the U.S. each year from complications and the most common complication is significant blood loss after birth or postpartum hemorrhage (PPH). 

PPH occurs when there is a blood loss of 500 cc or greater for a vaginal delivery and 1,000 cc after a cesarean section (C-section). Or, if you were admitted with a hemoglobin of 12 and it drops by ten points to 11, there should be a high index of suspicion for PPH as well. Therefore, if you feel lightheaded or dizzy, have palpitations or an increased heart rate after delivering a baby, inform the hospital staff immediately.

The most common cause of PPH is uterine atony or lack of contractions after the baby is delivered. Any pregnant condition that stretches the uterus significantly — such as having twins or a higher gestation, excess amniotic fluid (aka polyhydramnios), a prolonged induction of labor (greater than 24 hours) — increases the risk of PPH. Retained products of conception, such as the placenta, also places the patient at risk for developing PPH.

Other risk factors for PPH include:

  • Women with a known placenta previa
  • African-American women
  • Hypertension or preeclampsia
  • Mothers with infants weighing greater than 8.8 pounds (or 4,000 grams)
  • Mothers with greater than seven children
  • Women with a history of hemophilia

If you have any of the risk factors listed above, please be proactive and discuss the possibility of a PPH with your healthcare provider. Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*

Do Speeding Ambulances Save More Lives?

How fast should an ambulance go? The stereotypical speeding ambulance with lights flashing and sirens blaring is the image that most conjure up. But recent data suggests that transport speed may be overstated.

In a fascinating piece from Slate, emergency physicians Zachary F. Meisel and Jesse M. Pines examine that very question. They cite a recent study from the Annals of Emergency Medicine, which concluded that a fast transport speed didn’t necessarily save lives. Read more »

*This blog post was originally published at*

Man Dies Of Internal Bleeding After Rattlesnake Bites His Finger

In a recent issue of Wilderness & Environmental Medicine (Volume 20, Number 2, 2009), Anne-Michelle Ruha and Steven Curry have written an article entitled “Recombinant Factor VIIa for Treatment of Gastrointestinal Hemorrhage Following Rattlesnake Envenomation.” This is a “case report,” meaning that this is a description of a particular medical event, rather than a study.

To open the piece, the authors observe that North American rattlesnakes possess venom with properties that can cause severe physiological effects, such as low platelet count and, on occasion. bleeding. In this report, we learn about a 44 year old man who was bitten on the index finger by an unidentified (unknown for this case) species of rattlesnake. The victim developed massive gastrointestinal bleeding that was treated eventually with a product known as recombinant factor VIIa. His initial clinical presentation included an altered level of consciousness, profoundly low blood pressure (shock), sweating, and vomiting of bright red blood. Read more »

This post, Man Dies Of Internal Bleeding After Rattlesnake Bites His Finger, was originally published on by Paul Auerbach, M.D..

Extreme Bleeding

Recently I had a moment to reflect on adrenaline and adrenaline inducing sports. It was a bloody moment. But I’m getting ahead of myself.

Bleeding peptic ulcers occasionally cross the path of general surgeons. Usually they stop bleeding with conservative treatment. But sometimes they don’t. Then you need to whip out the trusty knife. Even then usually the operation is little more than routine. This case, however was exceptional.

He was white as a sheet. He had been bleeding for three days but only decided to come to the hospital when he started falling over. It seemed he could at least recognise falling over as not normal. The initial gastroscopy showed a penetrating duodenal ulcer with no active bleeding. the body had managed to curtail the bleeding, partially because of vasoconstriction, but mainly due to a low blood pressure which in itself was due to loss of blood. Read more »

*This blog post was originally published at other things amanzi*

Amylopectin Powder’s Amazing Ability Top Stop Hemorrhaging Fast

Michael Kilbourne and colleagues recently published an article entitled “Hemostatic Efficacy of Modified Amylopectin Powder in a Lethal Porcine Model of Extremity Arterial Injury”( Annals of Emergency Medicine 2009;53:804-810). The purpose of the study described in this article was to investigate the blood-stopping ability of a modified amylopectin powder in an animal (pig) model of severe limb bleeding created by an injury to the femoral artery.

Following creation of the injury, animals were treated either with regular gauze with manual compression or with specially modified amylopectin powder and manual compression. Some of the endpoints measured in the study were total blood loss, survival, and time to bleeding cessation.

Post-treatment blood loss in the amylopectin powder-treated group was much less (approximately 0.275 liter) than in the gauze group (approximately 1.3 liters). Bleeding was stopped in approximately 9 minutes in the amylopectin group, and never stopped in the gauze group. 100% of the amylopectin animals survived, and none of the gauze animals survived.

While this study was directed to improve care for victims of major trauma (including wartime situations), the applicability to situations in the outdoors is direct. Many blood-stopping bandages have come to the civilian market, and they are quite useful. I carry them with me whenever I’m going into the wilderness, and often when I cover athletic events as the team doctor. They’re useful for nosebleeds and cuts, not just for severe injuries. Some of the product names include HemCon Bandage, QuickClot, BleedArrest, QR, Celox, and BloodStop. There will undoubtedly be improvements in these products, in particular the delivery systems, be they bandages or powders.

image courtesy of

This post, Amylopectin Powder’s Amazing Ability Top Stop Hemorrhaging Fast, was originally published on by Paul Auerbach, M.D..

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