Post-Partum Haemorrhage
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
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.