1. Guideline by the RCOG
 MONITOR / INVESTIGATE.
STOP THE BLEEDING.
RESUSCITATE.
COMMUNICATE.

2. COMMUNICATE
call 6
• Call experienced midwife
• Call obstetric registrar & alert consultant
• Call anaesthetic registrar , alert consultant
• Alert haematologist
• Alert Blood Transfusion Service
• Call porters for delivery of specimens / blood

3. MONITOR / INVESTIGATE
• Cross-match 6 units
• Full blood count
• Clotting screen
• Continuous pulse / BP /
• ECG / Oximeter
• Foley catheter: urine output
• CVP monitoring

4. Placenta Previa
Management
Severe
bleeding
Caesarean
section
Moderate
bleeding
Gestation
>34
<34
Resuscitate
Steroids Unstable
Stable
Resuscitate
Mild
bleeding Gestation
<36
Conservative care
>36

5. PPH

6. MANAGEMENT OF PPH
Send Blood Samples

7. MANAGEMENT OF PPH

8. DRUG THERAPY FOR PPH
Misoprostol 1000ugm use by rectum
Tranexamic acid 1g/ml IV at 1ml per minute(administered over 10minutes)
Second dose of 1g IV if bleeding continues after 30minutes.

9. MANAGEMENT OF PPH

10. MANAGEMENT OF PPH

11. MANAGEMENT OF PPH

12. MANAGEMENT OF PPH

15. Uterine Tamponade(1)

16. Rush hydrostatic balloon catheter

17. Uterine Tamponade(2)

19. Management protocol for Eclampsia
• Management (carried out by a team):
 Turn the patient on her side
 Insure clear airway(section,mouth,gag)
 Maintain IV access.
 Stop fits mag.sul,diazepam
 Control Bp (hydralazine,Labetalol)
 Intake and output chart
 Investigation(urine,FBC, RFT, LFT, clotting profile, cross match)
 Monitor patient and her fetus
 After stabilization (Bp controlled, no convulsions, hypoxia controlled)
deliver

20. . Loading dose
 Give MgSO4, 4g+ 20ml NS or sterile
water I.V over 5-20 minutes Give 10g
(i.e. 20ml of 50% solution) 5g in
each buttock as deep I.M wih1ml
of 2% lignocaine in the same
syringe
INTRAMUSCULAR REGIMEN
Maintenance dose
 MgSO4 5 g (i.e. 10ml of 50%
solution) + 1 ml lignocaine 2%, 4
hourly in alternate buttocks.
 Ringer lactate or normal saline 30
drops/min. or 1 litre in 6-8 hrs.
 Maternal glucocorticoid therapy
at 24-34 wk for foetal lung
maturation
Expedited delivery?
no?< 23 weeks: counseling for termination
of pregnancy
23-32 weeks: steroids,
antihypertensive medications, daily
maternal and fetal evaluation, delivery
at 34 weeks
32-33 weeks: amniocentesis immature
fluid steroids, delivery in 48 hours
N.P Hemolysis
o abnormal peripheral smear
o lactate dehydrogenase > 600 U/L
Elevated liver enzymes
o serum aspartate aminotransferase > 70 U/L
o lactate dehydrogenase > 600 U/L
 low platelets
o platelet count < 100,000/mm3
Blood Should be sent for :
• Serum electrolytes
• Liver function tests
• Full Blood count
• Clotting test
• Group and save serum
• Renal function tests / urine acid test0
Management protocol for Eclampsia

21. Eclampsia - anticonvulsant therapy
Diazepam useful for status seizures mechanism of action facilitate the
binding of GABA to its receptor benzodiazepine receptors dosage - 10
mg at a rate of 5 mg per min may be repeated at 10 to 15 minute
intervals