Manage Postpartum Hemorrhage

Don’t fail to recognize PPH – even the most subtle ongoing bleeding post-delivery can qualify - A Pickens

Manage Postpartum Hemorrhage
Manage Postpartum Hemorrhage

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3 Thoughts

As a veteran of many a PPH, I’d just add in a couple of thoughts: – If the patient is not bleeding much, don’t worry too much about delivering the placenta immediately. It can take a few minutes (or sometimes half an hour or more) for “separation” to occur, after which time the placenta comes away pretty easily on it’s own. If you’re pulling on the cord before then (even gently) there is an increased risk of uterine inversion or retained products...

When in doubt – the highest yield intervention is bimanual compression. You don’t have to remember any drug doses and can do that for as long as it takes to have help arrive to start thinking about all the drugs.

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 3 Thoughts

As a veteran of many a PPH, I’d just add in a couple of thoughts...

First10EM

All patients get oxytocin: Either 10 units IM or 40 units in 1L of normal saline, run open until the uterus is firm, then at 200ml/hr (ACOG 2017; Anderson 2007; WHO 2012).

RebelEM

Blood loss > 500 ml after a delivery (or > 250 ml after an abortion). The management of post-abortion hemorrhage is similar to that of post-partum hemorrhage (PPH).

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