AWHONN Day 2

More learning going on here...I wish I could post the whole power points for you on some of these subjects for there has been so much information to share...but I'm going to give you the very short version so that this post doesn't get way out of hand ~

The first session of the day was on postpartum cardiomyopathy.  A women's heart has more work to do during pregnancy.  And some hearts do not tolerate all of the changes in blood volume and extra demands on the heart.  The outcomes are tragic as the symptoms of heart disease are often missed in pregnant women.  All I will say is that my patients who come in with shortness of breath and a fast heartrate will certainly be checked a little more fully by me  (I've already had the chance to ask a doctor for an EKG and an echocardiogram on a patient that had previously had a heart valve replacement)

The second lecture of the day was on postpartum hemorrhage.  I didn't learn a whole lot of new information from this lecture for we already have a bleeding algorithm where I work and bleeding orders.  Ours are very similar to the ones we saw in the lecture today.  Basically you need to have a system in place to handle a hemorrhage ~ for pregnant women can bleed fast and bleed alot.  We came in to the lecture to find this on our table:

Only at an obstetrical conference - RIGHT?  Can you guess how much blood loss this is??

It is 150ml.  

Not really alot. The most important thing is that you need to weigh the loss.  1gm = 1ml of blood loss.  We can't just 'quesstimate' as has been done in the past for it is frequently underestimated and by the time we realize something is going on and it can be too late to give appropriate treatment.

After lunch we learned about delayed cord clamping.  Delaying the clamping of the cord would give the baby a little extra boost of it's own blood and this may be beneficial.

Here are a few points from the lecture:

• 80 mls of blood gets transferred in the first minute,and 100 mls by 3 minutes after birth

• This blood supplies extra iron of 40-50 mg/kg

• Term infants are born with approximately 75 mg/kg so this increases the total iron to 115- 125 mg/kg

• WHO ( 2012)

• Increase of cerebral blood flow

• Better perfusion and circulation to the gut 

• Increased blood pressure 

• Increased hematocrit, hemoglobin levels and ferritin 

• Decreased iron-deficiency anemia

• Increased duration of breastfeeding 

World re-known, Penny Simkin does a good job of explaining the concept:

Know more about labor and birth now then you ever wanted to know?

Debbie