Postpartum Hemorrhage - Differential Diagnosis and Management
Uterine Atony (80%) - Most PPH Will respond to first line atony treatrrEnts
• Uterine massage
• Oxytocin 40 IU in 1 liter IVNS
• Drain bladder with Foley
• If continued bleeding:
- Misoprostol (Cytotec) 400 mcg sublingually or 1 g per rectum
- TXA 1 g over 10 minutes, may repeat xl
• If continued bleeding:
- Methylergonovine (Methergine) 0.2 mg IM (contraindicated in hypertension)
- Carboprost (Hemabate) 250 mcg IM q 15 min prn (contraindicated in asthma)
Retained products of conception - Does placenta deliver easily and look complete?
1. Maternal analgesia
2. Using external abdominal hand, push uterus inferiorly (toward intravaginal examining hand)
3. Sweep inside of uterus with hand to gather POC
Trauma to birth canal - inspect vagina and cervix
• Direct pressure
• Laceration repair with suture (2-0 Vicryl)
• Inject with epinephrine prn
DIC/occult coagulopathy
• CBC, fibrinogen, PT/PTT
• Treat with cryoprecipitate prn
• TEG if available
Maneuvers for life-threatening bleeding unresponsive to usual treatment:
• Intrauterine balloon tamponade with Bakri Balloon or equivalent
• Uterine packing with gauze/procoagulants
• External aortic compression (using ultrasound if available)
• REBOA / Laparotomy / Cesarean
#Postpartum #Hemorrhage #Differential #Diagnosis #Management #obstetrics #obgyn
