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Ante-partum Haemorrage:

Post-partum Haemorrhage:

  • In Australia PPH has an incidence rate of between 5 to 15% and remains a leading cause of maternal death.
  • PPH can lead to hypovolaemic shock and maternal death if not managed.
  • Most birth cases require minimal active management but a small percentage of patients may become compromised.
  • Causes of PPH include the four Ts;
    • Tone - lack of the uterine tone (Atony)
    • Trauma - uterus, cervix, vagina or perineum
    • Tissue - retained products of conception
    • Thrombin – Blood clotting disorders

Information Needed:

Present History: 

  • Duration
    • Time started; continuous or spontaneous
  • Amount of bleeding
    • Description of bleeding; spotting, heavy, clots, pain/cramps
  • If pregnant
    • Consider also miscarriage or abortion
  • Any bloody urine or blood in stools
  • Recent injury
  • Recent surgery
  • Postpartum bleed, vaginal trauma, soft uterus, bleeding disorder

Past History:

  • Any previous episodes?

Signs and Symptoms:

  • Cramping
  • Evidence of blood loss and type
  • Clots or tissue?
  • Fever
  • Pain
  • Dizziness
  • Weakness
  • Thirst
  • Other signs of hypovolaemic shock
    • e.g. vasoconstriction, sweating, altered consciousness

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St John WA
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