Diagnostic Tests for Postpartum hemorrhage

Postpartum hemorrhage Tests: Book Excerpts

• Diagnostic Approach - Purpura/Petechiae/Excessive Bleeding

Postpartum hemorrhage Diagnosis: Book Excerpts

• Differential Diagnosis - Bleeding (Excessive)
• Diagnosis - Cesarean birth
• Differential Overview - Purpura/Petechiae/Excessive Bleeding

Diagnostic Tests for Postpartum hemorrhage: Online Medical Books

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Purpura/Petechiae/Excessive Bleeding: Diagnostic Approach
(Field Guide to Bedside Diagnosis)

A patient with a suspected bleeding disorder should be questioned about response to trauma, past bleeding problems, for example with surgery or dental extractions, history of transfusion, menstrual history and dietary habits. Absence of abnormal bleeding with surgery, significant trauma, or dental extractions makes an inherited bleeding disorder unlikely.

Petechiae are small capillary hemorrhages resulting from platelet or vascular abnormalities. Petechiae on the lower extremities or mucous membranes are usually caused by thrombocytopenia. Tender, elevated petechiae plus abnormalities in other organs suggests vasculitis. Platelet defect disorders produce petechiae and ecchymoses occurring immediately after local trauma. Bleeding is superficial, occurring in the skin, the mucous membranes, the nose, and the gastrointestinal and genitourinary tracts. Bleeding does not occur with normal platelets until the count falls to less than 50,000, and the threshold for important bleeding is 20,000. Oozing blood around catheters suggests DIC, vitamin K deficiency, or platelet abnormalities.

Large-area bruising occurs with vitamin-K–dependent factor deficiency, but not with hemophilia. Plasma protein disorders produce bleeding in deep tissues, such as joints, muscle, and retroperitoneum. The onset of such bleeding can be delayed for hours after trauma.

Palpable purpura is seen with autoimmune or infectious (e.g., meningococcemia, endocarditis) vasculitis. Infectious emboli have an irregular outline, whereas lesions of leukocytoclastic vasculitis are circular.

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Source: Field Guide to Bedside Diagnosis, 2007

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