This document discusses postpartum haemorrhage (PPH), defined as blood loss greater than 500ml after a vaginal delivery or 1000ml after a cesarean section. It outlines prevention through risk identification and treatment protocols. Causes of PPH are explored through history and examination. Management is directed at the underlying cause and may include uterotonic drugs, tranexamic acid, uterine massage, and identifying uterine inversion. Knowledge of treatment protocols is assessed through sample cases. Recommended additional reading on diagnosis and management of PPH is provided.

1. POSTPARTUM
HAEMORRHAGE
Definition
Prevention
Causes
Management
Test your
knowledge
Recommended
Reading

2. WHAT IS PPH
• PRIMARY PPH OCCURS IN THE FIST 24 HOURS
AFTER DELIVERY
BLOOD LOSS >500ML AFTER A VAGINAL
DELIVERY, OR
>1000ML AT CAESAREAN SECTION
• SECONDARY PPH IS DEFINED AS EXCESSIVE
VAGINAL BLEEDING FROM 24H AFTER DELIVERY
UP TO 6 WEEKS POSTPARTUM

3. PREVENTION OF PPH
Fe
supplements
prevent
anaemia,
decrease
PPH, better
compensatio
n
Anticipate
PPH
Refer hi-risk
women to 3°
centre
Have
equipment,
blood
products
available
Use
partogram
Prevent
prolonged
labour
Active
management
of 3rd stage
Monitor vital
signs closely
post-delivery

4. ESTABLISH
CAUSE OF
HAEMORRHAG
E
GOOD HISTORY
AND SYSTEMATIC
EXAMINATION TO
DETERMINE RISK
FACTORS AND
CAUSE
MANAGEMENT
DIRECTED
TOWARDS THE
CAUSE

5. MANAGEMENT
1. RESUSCITATION
2. IV LINE WITH 30U PITOCIN
(SYNTOMETRINE 1 AMP IF NO C/I)
3. MISOPROSTOL 5 TABS PR
4. TRANEXAMIC ACID 1G IVI
5. RUB UP THE UTERUS
6. URINE CATHETER
7. ESTIMATE BLOOD LOSS
8. DETERMINE CAUSE OF PPH
9. MANAGE AS PER CAUSE (VIEW QR
CODE)
WATCH THIS VIDEO THAT ILLUSTRATES
THE STRICT PROTOCOL MANAGEMENT
OF PPH

6. TEST YOUR KNOWLEDGE
• MRS X DELIVERED A BABY 15 MINUTES AGO. THE
DELIVERY OF THE PLACENTA WAS DIFFICULT AND
SHE IS NOW BLEEDING PROFUSELY. THE UTERUS
CANNOT BE PALPATED ABDOMINALLY. WHICH
DRUG DO YOU ASK YOUR ASSISTANT TO
ADMINISTER AS PART OF MANAGEMENT OF MRS
X?
TOCOLYTIC OXYTOCIC
More
question
s

7. CORRECT
CONGRATULATIONS, YOU HAVE JUST HELPED SAVE A
LIFE!

8. INCORRECT
MRS X CONTINUES TO BLEED.
PLEASE KEEP TRYING TO SAVE HER LIFE
Hint:
Her most likely
diagnosis is
uterine inversion

9. RECOMMENDED READING
• CHANDRAHARAN, E., & KRISHNA, A. (2017, 10 06). DIAGNOSIS AND
MANAGEMENT OF POSTPARTUM HAEMORRHAGE. BMJ, 358-363.
RETRIEVED FROM HTTPS://MEDIKOE.COM/ARTICLE/POST-PARTUM-
HEMORHAGE-1312
• HIGGINS, N., PATEL, S. K., & TOLEDO, P. (2019). POSTPARTUM
HEMORRHAGE REVISITED: NEW CHALLENGES AND SOLUTIONS. CURRENT
OPINION IN ANESTHESIOLOGY, 278-284.
• KHALID, K. (2019, OCTOBER 06). POST PARTUM HAEMORRHAGE.
RETRIEVED FROM MEDIKOE: HTTPS://MEDIKOE.COM/ARTICLE/POST-
PARTUM-HEMORHAGE-1312
• MAKHUBO, N., JD, MAKIN., & S, ADAM. (2018). USE OF A VISUAL AID TO
IMPROVE ESTIMATION OF BLOOD LOSS IN OBSTETRICS. SAJOG, 18-21.
• O'BRIEN, K. L., SHAINKER, S. A., & LOCKHART, E. L. (2018). TRANSFUSION
MANAGEMENT OF OBSTETRIC HEMORRHAGE. TRANSFUSION MEDICINE
REVIEWS, 249-255.
• SENTILHES, L. ,.‐J. (2018). FIGO CONSENSUS GUIDELINES ON PLACENTA