Postpartum hemorrhage
From IDWiki
Definition
- Blood loss >500mL within 24h after delivery
Epidemiology
- The leading cause of maternal mortality in developing countries, accounting for 25% of all maternal mortality worldwide
Etiology
- Uterine atony
- Retained placental tissue
- Trauma
- Bleeding diathesis
Investigations
- Antenatal CBC
Management
- Prevention
- First-line
- Oxytocin 10 IU IM/IV once, during third stage of labour
- Monitor uterine tone
- Alternative: misoprostol 600mcg PO once, during third stage of labour
- Alternative: uterine massage
- Adjunct: continuous cord traction, only if skilled birth attendant
- First-line
- Treatment
- First-line
- Oxytocin
- Uterine massage
- Fluid resuscitation with isotonic crystalloids
- Adjunct (if first-line fails)
- Tranexemic acid
- Intrauterine balloon tamponade
- Temporizing measures
- Bimanual uterine tamponade
- External aortic compression
- Non-pneumatic antishock garments
- Last line
- Surgical intervention
- First-line
- Blood transfusion, if necessary