Postpartum haemorrhage: uterotonic ladder, tranexamic acid, and massive obstetric haemorrhage

Meet the patient

A 32-year-old para four woman delivers vaginally at 2am. The midwife calls you because the blood loss has passed a litre, the uterus is boggy, and the pressure is 84 over 50. She is pale, restless, and cold. Your registrar is reaching for the carboprost — but she is asthmatic, and that drug is bronchoconstrictive.^[11]

Two questions decide the next twenty minutes of every PPH: what is bleeding, and is the team running the protocol yet? The four Ts answer the first; the named MOH activation answers the second. Hold those two and the ladder below slots into place.^[12]

References16ShowHide

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