Medical Management of PPH

Contents

Indications for medical management of PPH

Early/suspected PPH: EBL>500ml with on-going bleeding
Ongoing bleeding despite early management with simple measures (See 5.1.5)

If bleeding continues despite simple measures, a cascade of directed interventions is begun. Medical therapy is instituted, taking into account the availability of i.v. access and also contraindications related to the patient’s medical history. The members of the team are made aware of the developing PPH. An i.v. and Foley are placed and the patient moved to the caseroom or OR if not already there. Uterine compression with bimanual pressure, uterine balloon or intrauterine packing would be the next step.

Preparation

Call for help –lab, anesthesia, nursing
I.V. access with RL or NS, start oxytocin infusion (40 IU in 1000ml)
Group and Match if not already done
Cascade of medical Tx (see moreob/uptodate for medical rx details)
Insert Foley to collapse bladder and monitor urine output
Transfer to caseroom for better exposure if not already there, think OR team if possible surgical intervention
Trial of uterine compression with uterine packing or intrauterine balloon (Bakri preferable if available but may use condom tied around Foley)

Pharmacological agents

Misoprostol (600-1000mcg s.l. or p.r.) (sl faster)
- Ergometrine (0.25mg i.m. or i.v.)
- Carboprost (0.25mg i.m. or myometrial)
- Tranexamic acid (1gm i.v.) consider push for initial dose