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Introduction
  • Post-partum Haemorrhage (PPH) is defined as blood loss > 500ml after childbirth / or blood loss that significantly compromises the mother.
Clinical Presentation
  • Blood loss > 500ml after birth
Exclusion Criteria
Exclusion Criteria
Risk Assessment
  • 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.
Management
Primary Care
  • Primary Survey
  • Offer continuous support and reassurance
  • Encourage mother to empty bladder
  • 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/suprapubic compression.
  • Secondary / CNS Survey (as required)
Intermediate Care (EMT / Level 2)
  • 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
Advanced Care (AP)
  • Apply cardiac monitor
  • Establish vascular access
  • Consider fluid therapy
  • 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
Critical & Extended Care (CCP, PSO)
  • As per Advanced Care (AP) guidelines
Additional Information
  • 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.

References
References
Key Terms & Links
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Directorate
Clinical Services

Responsible Manager
Head of Clinical Services

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