EM · Postpartum haemorrhage

Postpartum haemorrhage

Also known as PPH · Primary postpartum haemorrhage · Obstetric haemorrhage

The postpartum haemorrhage — the primary PPH (the blood loss over 500 mL within the 24 hours of the delivery, or the over 1000 mL after the Caesarean) and the secondary PPH (the bleeding from the 24 hours to the 12 weeks postpartum). The four Ts of the cause (the Tone — the uterine atony, the commonest at 70 per cent; the Trauma — the vaginal or the cervical tear; the Tissue — the retained products; the Thrombin — the coagulopathy). The management: the ABCDE, the two large-bore cannulae, the crossmatch 4 units, the fluid resuscitation, the uterotonics (the oxytocin 10 IU IM or 5 IU IV, the ergometrine 500 mcg IM — avoid in the hypertension; the carboprost 250 mcg IM every 15 minutes up to 8 doses — avoid in the asthma; the misoprostol 800 mcg per rectum), the tranexamic acid 1 g IV, the Bakri balloon, the bimanual compression, the surgical ligation, the hysterectomy for the refractory. ACEM-primary, globally tagged.