Emergency Procedure: Postpartum haemorrhage

The Procedure

Hello again from the Emergency Procedures team.

Today we step out of our comfort zone and tackle postpartum haemorrhage (PPH). Take a few deep breaths and your own pulse, then dive into the video

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So, without further ado…here is the video

The rationale…

What’s the main thing I need to remember about complications of childbirth in the ED?

Get help early……….

A deliver in the emergency department is not a normal delivery, it is unexpectedly rapid labour known as a precipitous delivery. Precipitous deliveries have high rates of complications including breech delivery, shoulder dystocia, nuchal cord, and post-partum haemorrhage.

We need to prepare for the worst.

Put out a neonatal and obstetric emergency call for all births occurring in or on the way to the ED.  

Remind me of the causes of PPH?

The common causes of PPH are:

• TONE: Reduced uterine tone (70%)
• TRAUMA: laceration, rupture of uterus (20%)
• TISSUE: Retained placenta or blood clots (10%)
• THROMBIN: Coagulopathy (1%)

Post partum haemorrhage may be external, intraabdominal, retroperitoneal, or in the pelvic floor and is not always associated with large vaginal blood loss (>500ml).

What key information do I need to remember for managing PPH?

Resuscitate with a massive transfusion as you would for any trauma.

Compress visible bleeding sources (trauma).

Treat uterine atony mechanical (bi-manual compression) and with uterus constricting medications.

Aim for specialist interventions in theatre if unresolved after 30 mins.

What do I need to remember about the uterotonic (uterus constricting) medications?

We always oxytocin and TXA which should be available in the ED.

You need to remember not to focus on specialist medications (ergometrine, carboprost) too much.

If bleeding does not settle the patient needs to be in the operating room within 30 mins. You can give other uterotonics if available and it does delay progress to theatre

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