NATIONAL PROTOCOL FOR MANAGEMENT OF POSTPARTUM HAEMORRHAGE (PPH) Blood loss > 500ml after vaginal birth or > 1000ml after caesarean birth Any loss that threatens the life of the patient Primary PPH: Occurs within 24 of delivery; Secondary PPH: Occurs after 24 hours of delivery Make plans to transfer to CEmONC early with an IV line in place! SIGNS AND SYMPTOMS Heavy bleeding Pale conjunctiva or pallor pulse, falling BP, rapid respiration Restlessness or confusion INVESTIGATIONS & ACTIONS Call for help Do check to determine cause: Tone, Tears, Tissue, Thrombin Insert large IV line and start IV fluids & send HB, blood type, cross-matching, bedside clotting time MANAGEMENT UTERINE ATONY LACERATION RETAINED PLACENTA COAGULOPATHY (TONE) (TISSUE) (THROMBIN) Massage uterus Confirm uterus is Massage Massage Catheterize firm uterus uterus Oxytocin 40 IU in 1L NS Catheterize Catheterize fast (or 10 IU IM), then Examine cervix, Oxytocin 40 continue at 40 drops/min vagina, perineum IU in 1L NS Oxytocin for 6hrs Provide analgesic Retained 40 IU in 1L & antibiotic placenta with NS ↓ Misoprostol 800mcg Repair laceration NO BLEEDING Transfuse sublingually or rectally under anesthesia is high risk for fresh If uterine rupture accreta whole ↓ – Bimanual compression or - laparotomy TRANSFER to blood and external aortic compression CEMONC and fresh ↓ do not frozen Uterine Balloon Tamponade attempt plasma (antibiotics) removal! (FFP) ↓ Do manual Tranexamic Tranexamic acid 1g IV slowly acid 1g IV (if removal of per protocol if available available) placenta ↓ Laparotomy
NATIONAL PROTOCOL FOR MANAGEMENT OF POSTPARTUM HAEMORRHAGE (PPH) Blood loss > 500ml after vaginal birth or > 1000ml after caesarean birth Any loss that threatens the life of the patient Primary PPH: Occurs within 24 of delivery; Secondary PPH: Occurs after 24 hours of delivery Make plans to transfer to CEmONC early with an IV line in place! SIGNS AND SYMPTOMS Heavy bleeding pulse, falling BP, rapid respiration Pale conjunctiva or pallor Restlessness or confusion INVESTIGATIONS & ACTIONS Call for help Do check to determine cause: Tone, Tears, Tissue, Thrombin Insert large IV line and start IV fluids & send HB, blood type, cross-matching, bedside clotting time MANAGEMENT UTERINE ATONY (TONE) LACERATION RETAINED PLACENTA (TISSUE) COAGULOPATHY (THROMBIN) Massage uterus Catheterize Oxytocin 40 IU in 1L NS fast (or 10 IU IM), then continue at 40 drops/min for 6hrs ↓ Misoprostol 800mcg sublingually or rectally ↓ Bimanual compression or external aortic compression ↓ Uterine Balloon Tamponade (antibiotics) ↓ Tranexamic acid 1g IV slowly per protocol if available ↓ Laparotomy Confirm uterus is firm Catheterize Examine cervix, vagina, perineum Provide analgesic & antibiotic Repair laceration under anesthesia If uterine rupture - laparotomy Massage uterus Catheterize Oxytocin 40 IU in 1L NS Retained placenta with NO BLEEDING is high risk for accreta – TRANSFER to CEMONC and do not attempt removal! Do manual removal of placenta Massage uterus Oxytocin 40 IU in 1L NS Transfuse fresh whole blood and fresh frozen plasma (FFP) Tranexamic acid 1g IV (if available)
national-protocol-for-management-of-postpartum-haemorrhage.docx