This document provides guidelines for managing postpartum haemorrhage (PPH). It emphasizes the need for immediate action, as death from PPH is usually rapid without treatment. The guidelines recommend following the principles of CALL, RESUSCITATE, MONITOR/INVESTIGATE, and STOP THE BLEEDING. First-line treatment includes uterotonics like oxytocin, ergometrine, and misoprostol. Other measures discussed include bimanual compression, condom catheter tamponade, and surgical techniques if conservative options fail. Early recognition, teamwork, and following standardized protocols are essential to optimize outcomes for mothers experiencing PPH.
5. How much time do we have ?
It is estimated that, if untreated,
Death occurs on average in:
12 hours from Antepartum Hemorrhage
2 days from Obstructed Labor
6 days from Infection
2 hours from Postpartum Hemorrhage
6. WHY DRILLS IN OBSTETRICS ?
PPH
• Death from PPH is avoidable
• Are Mostly Unexpected –
Immediate and Adequate
action needed
12. 14 GUAZE – 2 IN NUMBER
Venepuncture (20 ml)
for:
• Crossmatch (4 units minimum)
• Full blood count
• Coagulation screen including
fibrinogen
• Renal and liver function for
baseline.
START RINGER LACTATE
TILL BLOOD COMES
13. Transfuse blood as soon as
possible
• Infuse 2 litres of
warmed Crystalloid
Hartmann’s solution
• Colloid (1–2 litres) as
rapidly as required.
• RAPID WARMED
infusion of fluids.
14. If crossmatched blood is still
unavailable
Uncrossmatched Group Specific Blood
OR
‘O RhD Negative” Blood
15. MONITORING
• Keep position Flat
• Keep the woman warm using appropriate
available measures.
• Temperature every 15 mts
• Continuous pulse, blood pressure recording and
respiratory rate
• Foley catheter to monitor urine output.
Documentation of fluid balance, blood, blood products and procedures.
17. Bimanual Compression
If uterus is relaxed :
massaging the uterus
will expel any
retained bits &
stimulate uterine
contractions
18. UTEROTONICS -- OXYTOCIN
10 IU IM.
Or
• 20–40 IU in 1 L of normal saline at 60
drops per minute.
• Continue oxytocin infusion (20 IU in 1 L of
IV fluid at 40 drops per minute) until
hemorrhage stops
FIGO Safe Motherhood and Newborn Health (SMNH) Committee /
International Journal of Gynecology and Obstetrics 117 (2012) 108–118
19. OXYTOCIN – FIRST LINE
Storage
• preferred storage is refrigeration
• it may be stored at temperatures up to 30 °C for
up to 3 months without significant loss of
potency
20. ERGOMETRINE
Dose: 0.2 mg im or slow iv
Repeat 0.2 mg after I/M can be repeated every 2-4
hrs
Maximum 5 doses (1 mg) in 24 hr
Storage:2–8 °C and protect from light and from
freezing
•Hypertension is a relative contraindication
•Contraindicated with concomitant use of certain drugs used
to treat HIV
21. OR
• Syntometrine (combination of oxytocin 5
units and ergometrine 0.5 mg).
1 ampoule IM (warning, IV could cause
hypotension).
22. OR
• Misoprostol (if oxytocin is not available or
administration is not feasible).
Single dose of 800 μg sublingually (4×200-μg tablets).
Storage: aluminum blister pack, room
temperature, in a closed container.
24. AORTIC COMPRESSION
• It is simple life saving procedure
• Aortic compression may be used to stop
bleeding at any stage.
• Ideally, the birth attendant should
accompany the woman during transfer
FIGO GUIDELINES 2012
Prevention and treatment of postpartum hemorrhage in low-resource settings☆
FIGO Safe Motherhood and Newborn Health (SMNH) Committee
34. Documentation and Debriefing
Important to record:
• Sequence of events
• Time and sequence of administration of
pharmacological agents, fluids, blood
products
• The time of surgical intervention
• The condition of mother throughout .
43. It is an Enigma
• It is sudden
• often unpredicted
• assessed subjectively
• Can be catastrophic.
The clinical picture changes so rapidly that unless
timely action is taken maternal death occurs within
a short period.
44. To Conclude, Management of PPH
Has Evolved From:
• Panic
• Panic
• Hysterectomy
Pitocin
Prostaglandins
Happiness