This document provides guidelines for managing postpartum haemorrhage. It outlines steps to take including calling for help, evaluating vital signs, establishing an IV line, administering oxygen, checking if the placenta has been delivered, massaging the uterus, giving medications like oxytocin and misoprostol, and providing nursing care such as monitoring blood loss. It further describes performing bimanual compression of the uterus if bleeding continues, which involves emptying the bladder, inserting a gloved hand into the vagina to apply pressure on the uterus while the other hand applies counter pressure on the abdomen.

2. MANAGEMENT OF POST PARTUM
HAEMORRHAGE

3.  CALL FOR HELP
 Mobilize the all available health personnel.

4.  EVALUATE VITAL SIGNS:
 The pulse: should not be weak or rapid
110mmhg/mt or more.
 Respiration: respiration rate should be more
than 30 breath/mt
 Blood pressure: should not be less than
90mmhg
 Monitor the vital signs to estimate the blood
loss.
 Keep the women covered with a blanket. If she
is in shock to maintain body temperature.

6. ESTABLISH
THE IV LINE
draw blood for
grouping and
cross
matching.
Start rapid
infusion of RL
one litre in 15-
20 mts

7. ADMINISTE
R OXYGEN
6-8 lt/mt by
mask

8.  CHECK TO SEE THE PLACENTA
DELIVERED OR NOT:
 NOT DELIVERD: If retained placenta give inj.
oxytocin 20 IU in 500ml of RL , 40-60/mt
 If delivered: Examine placenta and membrane
for completeness. If it is not complete suspects
the retained placental fragments.
 Remove the placental fragments and
membranes digitally with sponge holding
forceps under the supervision of medical
officer.

9.  Feel the consistency of uterus per abdomen.
 If uterus is well contracted it indicates traumatic
PPH.
 Give uterine massage. Watch for tears and
lacerations in vagina and cervix.
 Suture the tears under the supervision of
medical officer .
 If still bleeding is present then give inj.
Oxytocin 20IU in 500ml of RL/NS 40-60/mt.

10. MASSAGING THE UTERUS

11.  And give tab
mesoprostal 200mg
oral.
 1-4 tablets that is
200-800mg through
the rectum
 Inj.mesoprostal 1mg
intravenous for
active management
of 3rd stage labour

12.  NURSING MANAGEEMENT:
 Foot end elevation
 Watch the level of consciousness
 Watch the amount of blood loss(soaking one
pad or cloth in less than 5mt indicates heavily
bleeding)
 Keep the patient in NBM
 Manage the uterus to expel the blood clots
which will inhibit the uterine contraction.

14.  For assessing the bleeding using of Brass-v
blood collection drape and counting of pads.
 If still bleeding occur give bimanual
compression of uterus.

15.  Steps of bimanual
compression:
 Empty the bladder
 Wear sterile gloves
 Insert a gloved hand
into the vagina from
a first and apply
pressure against
anterior wall of the
uterus.

16.  Maintain compression until bleeding is
controlled and the uterus contract
 Left hand placed on abdomen and give negative
pressure.
 After giving bimanual compression if the
bleeding is not controlled pack the vagina and
refer to F.R.U.