Post-Partum Haemorrhage

Introduction

Hemorrhage, exceeding the usual 500 ml of a normal delivery that occurs in the first 24 hours (usually immediately) following the delivery of the child. Post-partum is mostly due to placental retention and uterine atonia, but may also result from uterine rupture or cervical or vaginal lacerations.

Management

• If systolic BP is < 90 mmHg, elevate the legs (keep or replace the patient's feet in the delivery table stirrups).
• Under general anaesthesia and antibiotic prophylaxis (ampicillin or cefazolin IV, 2 g as a single dose): manual removal of the placenta (if not yet delivered) and systematic manual exploration of the uterus to remove any clots / placental debris and to make sure the uterus has not ruptured.

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• oxytocin: 5 to 10 IU by slow IV injection, and at the same time, start an IV infusion with 20 IU of oxytocin in 1 liter of Ringer lactate or 0.9 % sodium chloride, to be administered over 2 hours (160 drops / minute).
• Check for injury to the cervix or vagina using retractors (or speculum). Massage of the uterus to expel any clots and aid uterine retraction. Insert a urinary catheter to facilitate uterine retraction.
• Continue monitoring (pulse, BP, blood loss). Bleeding should diminish and the uterus should remain firm.