Postpartum hemorrhage
Background
Causes
- Uterine atony
- Retained placental fragments
- Lower genital tract lacerations
- Uterine rupture
- Uterine inversion
- Hereditary coagulopathy
Differential Diagnosis
3rd Trimester/Postpartum Emergencies
- Acute fatty liver of pregnancy
- Amniotic fluid embolus
- Chorioamnionitis
- Eclampsia
- HELLP syndrome
- Mastitis
- Peripartum cardiomyopathy
- Postpartum endometritis (postpartum PID)
- Postpartum headache
- Postpartum hemorrhage
- Preeclampsia
- Resuscitative hysterotomy
- Retained products of conception
- Septic abortion
- Uterine rupture
Management
- Fluid resuscitation
- Consider Blood Products for Hemodynamic Instability
- Treat underlying cause:
- Uterine atony:
- Bimanual Massage
- Oxytocin (Pitocin) 10mg IM or slow IV push (rapid administration may cause hypotension)
- Misoprostol (Cytotec) 600mcg SL
- Methylergonovine (Methergine) 0.2mg IM (contraindicated in pts with HTN or Preeclampsia)
- Carboprost (Hemabate) 250mcg IV (avoid in pts with HTN or asthma)
- Bakri balloon placement (or substitute with large or multiple Foleys)
- Uterine inversion:
- Manually replace placenta:
- Place hand inside the vagina and push the fundus cephalad along long axis of vagina
- Manually replace placenta:
- Uterine atony:
Source
Tintinalli