- Postpartum Haemorrhage (PPH) is defined as blood loss > 500ml after childbirth / or blood loss that significantly compromises the mother.
- Blood loss > 500ml after birth
- Severe PPH >1000ml after birth
- Visual estimation of blood loss is often underestimated. Clinical signs of poor perfusion should prompt a thorough assessment per Hypovolemic Shock CPG. Display a high degree of suspicion with frequent observations for all patients with PPH.
- Consider additional resources for care of the newborn, maintain momentum in care and commence transport as soon as possible to definitive care.
- Atony may be present if you fail to locate the fundus, or it feels soft.
- Primary Survey
- Offer continuous support and reassurance
- Keep the patient warm
- Perform maternal vital sign survey
- Consider oxygen
- Apply direct pressure to any visible bleed, such as tear of perineum
- Apply management principles as indicated in clinical skill Postpartum Haemorrhage
- Encourage breast feeding (which triggers uterine contraction)
- Consider fundus (uterine) massage
- In life threatening conditions, consider aortic compression.
- Secondary / CNS Survey (as required)
- Apply cardiac monitor if trained and authorised
- Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
- Transport Priority 1 if patient time critical, pre-notifying receiving facility
- Apply cardiac monitor
- Establish vascular access
- Consider fluid therapy
- Consider TXA
- Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
- Transport
- Priority 1 to nearest obstetric unit if patient time critical
- To booked obstetric unit if patient stable
- Pre-notify receiving facility in both circumstances
- As per Advanced Care guidelines
- Liaise with obstetrics unit in the metropolitan area, recording all advice on ePCR.
- Liaise with local hospitals in country areas, recording all advice given on ePCR.
Further Reading:
World Health Organization (2012), WHO recommendations for the prevention and treatment of postpartum haemorrhage
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