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
  • 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
  • Blood transfusion, if necessary