Postpartum Hemorrhage

More than 500cc blood loss within the first 24 hours after normal vaginal delivery, or more than 1000cc after cesarean section.

Incidence of 2-5%, with a recurrence rate of 20-25%.

Risk factors

Four T's: tone, tissue, trauma, thrombin

Tone: anything that predisposes to uterine atony

Tissue: preventing contractions

Trauma

Thrombin: coagulopathy

 

Prevention

PPH can be prevented by actively managing the third stage through giving oxytocin 5u IM or IV as the anterior shoulder delivers. This reduces risk of hemorrhage as well as retained placenta.

 

 

Management of PPH

ABC's

talk to and observe patient

start at least one large bore IV and run saline drip wide open

give oxygen

CBC, type and X-match

consider coagulation studies

 

Ensure good analgesia, good lighting, and good exposure

If the placenta is undelivered, remove manually, along with any potential clots.

Massage the uterus and explore for retained tissue, uterine inversion or rupture

inspect the perineum, vagina, and cervix for lacerations

catheterize the bladder

Medications

Give IV oxytocin 20-50 units/litre; run wide open in saline or Ringer's

ergot

hemobate

misoprostol

 

Refractory Cases

Reinspect, including previous surgical repair of lacs

Evaluate for acquired coagulopathy

 

If uterus remains atonic, prepare for OR