POSTPARTUM HEMORRHAGE

EARLY RECOGNITION

Shock index = Pulse Rate

SystolicBP
Normal: 0.5 to 0.7
In pregnancy 0.7 to 0.9

>0.9 Indicates state of shock that

needs urgent resuscitation

GET HELP
Hook o2 via Face mask 10-15 LPM
WHEN TO STOP
INSERT second IV Line SBP 90
RAPID IV TRANSFUSION OF FLUID: warm 2L PLR to run for 15 mins,
3rd litter 60ml/kg
DBP 60
RR 12-20
INSERT INDWELLING URINARY CATHER
FUNDAL MASSAGE
PR 60-100
Repeat CBC and fibrinogen O2 >95%
Monitor vs q15 x 2 hours
Elevate legs
TEMP 35-37
Keep patient warm HEMOGLOBIN >70
EVALUATE THE CAUSE SIMULTANEOUSLY
PLATELET >70

OXYTOCIN 20-80 UNITS IN D5LR 1L

METHERGINE 0.2mg IM every 15 minutes for 2 doses then every 2-4 hours
Carboprost 0.2mg IM every 15 minutes for 2 doses then 2-4 hours (max of 8 doses)
Carpotocin
Tranexamic Acid 1g IVq6

Class II (HR>100,
Blood loss of 1200-1500)
Or with continuing blood loss CLASS III AND IV (HR>120 Blood loss of
1800-2100ml)

Move to OR
Type and crossmatched of 2u PRBC And Transfuse Notify Blood bank to initiate MTP
if bleeding persist 6U PRBC
6 FFP
Thaw 2u FFP 6 PLATELET CONCENTRATE
10 CRYOPRECIPITATE
CBC PT/PTT Fibrinogen CMP 1:1:1
Warm patient keep 02 sat >95 Conservative SURGICAL treatment BUT DO NOT DELAY
Calculate Blood Loss q5-10 min HYSTERECTOMY
Compression suture
Uterine artery ligation
Calcium Gluconate 5MLof 10% IV
Vitamin K 5-10,g IM