Controlled Cord Traction (CCT) oxytocin in 1L of IV fluid, if necessary If CCT failed, remove placenta manually. Give Metronidazole If not possible refer to hospital 500mg IV, Benzylpenicillin 2 MU Placenta out: IV and Gentamycin Rub up a contraction 240 mg IM Give or repeat oxytocin 10 IU IM Refer to hospital with Expel the clots donors Empty bladder and maintain Check haemoglobin. indwelling catheter If cervix is open: Inspect the vagina with broad explore uterus by specula using a headlamp to gloved fingers to identify any visible mucosal remove clots, lacerations or to verify source of placental fragments bleeding from the uterine cavity. and membranes. Repair tears of vulva, vagina, Observe for 24 hours. perineum, cervix or uterus where Give ferrous sulphate present. 200 mg every 8 Check pulse and blood pressure hours, plus folic acid If uterine atony persists in spite of the 5mg once a day for 6 above: weeks Put 40 units of oxytocin in 1L of Refer urgently with normal saline or Ringer's lactate & escort of a nurse and run at 60 drops per minute initially, potential blood then 40 drops per minute with a donors if: cervix is maximum of 3L. closed or if bleeding If bleeding due to uterine atony does not stop persists, do bimanual compression. If there is no improvement, refer to hospital with donors and inform the most senior person available. Non-obstetric causes: Cervical causes such as cancer or a benign polyp Over 50% of cases of APH remain unexplained!
Controlled Cord Traction (CCT) If CCT failed, remove placenta manually. If not possible refer to hospital Placenta out: Rub up a contraction Give or repeat oxytocin 10 IU IM Expel the clots Empty bladder and maintain indwelling catheter Inspect the vagina with broad specula using a headlamp to identify any visible mucosal lacerations or to verify source of bleeding from the uterine cavity. Repair tears of vulva, vagina, perineum, cervix or uterus where present. Check pulse and blood pressure If uterine atony persists in spite of the above: Put 40 units of oxytocin in 1L of normal saline or Ringer's lactate & run at 60 drops per minute initially, then 40 drops per minute with a maximum of 3L. If bleeding due to uterine atony persists, do bimanual compression. If there is no improvement, refer to hospital with donors and inform the most senior person available. oxytocin in 1L of IV fluid, if necessary Give Metronidazole 500mg IV, Benzylpenicillin 2 MU IV and Gentamycin 240 mg IM Refer to hospital with donors Check haemoglobin. If cervix is open: explore uterus by gloved fingers to remove clots, placental fragments and membranes. Observe for 24 hours. Give ferrous sulphate 200 mg every 8 hours, plus folic acid 5mg once a day for 6 weeks Refer urgently with escort of a nurse and potential blood donors if: cervix is closed or if bleeding does not stop Non-obstetric causes: Cervical causes such as cancer or a benign polyp Over 50% of cases of APH remain unexplained!
guidelines_for_malawi_and_tanzania_with_foreword_20.11.13.docx