O72.1-3 + (Z51.2)
DESCRIPTION
Blood loss >500 mL after birth of the baby or any blood loss which results in haemodynamic instability (tachycardia and/or hypotension).
GENERAL MEASURES
Bimanual compression of the uterus.
Ensure delivery of placenta.
Check for local causes of bleeding.
Balloon tamponade of the uterine cavity should be considered if the patient is to be transferred to another facility.
MEDICINE TREATMENT
Prevention Z29.2
Active management of the 3rd stage of labour:
- Oxytocin, IM, 10 units.
Note:
- Delay cord clamping and cutting (after 1 minute)
- Deliver the placenta by controlled cord traction .
Treatment
Resuscitate.
Put up two IV lines of crystalloid, one of which should contain oxytocin 20 IU.
Cross match and hold blood for transfusion.
Monitor BP and pulse, and response to uterotonics every 15 minutes .
- Oxytocin, IV, 20 units in 1 L sodium chloride 0.9% at 250 mL/hour.
If uterus remains atonic (palpable above the umbilicus):
ADD
- Ergometrine, IM, 0.5 mg.
OR
- Oxytocin, IM, 5 units.
AND
- Ergometrine, IM, 0.5 mg.
- Avoid ergometrine in women with hypertension or cardiac disease, except in severe cases where the benefit is considered to outweigh the risk (discuss with a specialist).
- Repeat ergometrine 0.5 mg IM after 15 minutes if no response.
If still no response after 15 minutes:
- Tranexamic acid 1 g, IV, slowly over 10 minutes.
- Repeat after 30 minutes if there is ongoing vaginal bleeding.
In settings where oxytocin had NOT been administered as prophylaxis at birth:
- Misoprostol, sublingual, or rectal, 600 mcg as a single dose.