PostPartum Hemorrhage


ETIOLOGY

SYMPTOMS

EXAM

DIAGNOSIS

TREATMENT

PREVENTION

 

Loss of > 500 ml of blood following VAGINAL delivery
OR
1000 ml of blood following CESAREAN section
  • Tone (Uterine Atony)
    • Massage uterus
    • Pitocin 10ml/min
    • Methergine 2mg IM q2h
      • Contraindicated in presence of hypertensive disease state
         
    • Hemabate (PGF2) 25mg IM q15min
      • Contraindication: Avoid in asthmatic patients and is relatively contraindicated if the patient has hepatic, renal, or cardiac disease
         
    • Misoprostol (Cytotec, PGE1)
      Per rectum (400 mcg after placenta and 100 mcg at 4 and 8 hours postpartum, total 800-1000 mcg)*
       
  • Tissue (retained placenta)
    • Inspect
    • Consider conscious sedation
    • Manually examine uterus
       
  • Trauma
    • Vaginal wall, Cervix
       
  • Thrombophilia (Bleeding Disorders)
    • vonWillebrand dz Most Common.



Clinical Dx Mgmt
Uterus not palpable INVERSION
(rare)
Elevate vag. fornices
IV Oxytocin
Uterus like dough (boggy) ATONY
 
Uterine massage
Pitocin 10 cc/min
Methergine 2mg IM q2h (Contraindicated in presence of hypertensive disease state)
Hemabate (PGF2) 25mg IM q15min
Misoprostol (Cytotec, PGE1)
Per rectum (400 mcg after placenta and 100 mcg at 4 and 8 hours postpartum, total 800-1000 mcg)*
Tears vagina, Cervix LACERATION Suture & Repair
Placenta incomplete RETAIN Plac. Manual removal
or uterine curettage
Diffuse oozing DIC (Abruptio placenta, fetal demise, retained POC) Remove POC, ICU care, Blood products prn
Persistent bleeding Unexplained Ligate vessels
Hysterectomy