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.”
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