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Ocima Richard Draza: Postpartum Hemorrhage – A Practical Step-by-Step Management Guide
Ocima Richard Draza/LinkedIn
Jun 1, 2026, 11:16

Ocima Richard Draza: Postpartum Hemorrhage – A Practical Step-by-Step Management Guide

Ocima Richard Draza, Nurse at Canadian Specialist Hospital, shared a post on LinkedIn:

“Postpartum Hemorrhage

1. What is PPH?

Heavy bleeding after childbirth, It is common but dangerous, so quick action is essential.

2. Quick Assessment (3 steps)

  • Measure blood loss (weigh pads)
  • Check vital signs (pulse, BP)
  • Examine the uterus (size, tone greater than is it soft
    atonic?).

3. First-Line Actions (Do Immediately)

If the uterus is soft then Uterine massage

՛Rub up a contraction՛

If needed then Bimanual compression (one hand inside, one hand outside to squeeze the uterus).

4. Medical Management

IV access (large bore x 2),

Take blood for:

  • Hb
  • Platelets
  • Coagulation
  • Crossmatch.

Give Oxytocin

  • 5 IU IV bolus, then
  • Infusion (40 IU in 500 mL crystalloid).

Empty Bladder

  • Insert catheter – helps uterus contract better.

Fluid Resuscitation

  • Rapid crystalloid/colloid up to 3.5 L
  • Severe bleeding then give O-negative blood.

5. If Placenta Not Delivered

  • Try gentle controlled cord traction.
  • If still retained then manual removal under anesthesia.
  • Give antibiotics after manual removal.

6. Additional Uterotonics

Use if bleeding continues:

Ergometrine (IM)

  • Carboprost (IM)
  • Misoprostol (rectal)

7. Tranexamic Acid

  • TXA1g IV then improves outcomes in PPH.

8. Treat Trauma

  • If genital tract tears then examine and suture.

9. If Bleeding Still Continues

Balloon Tamponade

  • Insert a uterine balloon then fill with saline then compress bleeding site

Surgical Options

  • B-Lvnch suture (brace suture around the
    uterus)
  • Internal iliac artery ligation
  • Hysterectomy (last resort) – Interventional Radiology
  • Uterine artery embolization if stable for transfer.”

Ocima Richard Draza: Postpartum Hemorrhage - A Practical Step-by-Step Management Guide

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