management
Last reviewed 01/2018
- prevented by syntometrine (NB beware an unborn twin) (comprises syntocinon - phasic contraction - and ergometrine - tonic contraction)
- identify the at risk patients
In PPH: 1. Rubbing the uterus causes it to contract 2. Ergometrine, IV, 0.5 mgs 3. IV infusion of syntocinon 4. Blood: cross match, Hb levels and coagulation 5. Catheterise and monitor output 6. Monitor CVP 7. Bimanual squeezing of the uterus 8. Contracted uterus but still bleeding: EUA - vulva, vagina, cervix - check for laceration Examine placenta - ie checking for RPOC. 9. Persistent atony: IV prostaglandins (or myometrial) 10. Laparotomy: internal iliac artery ligation 11. Hysterectomy (last resort)