 To understand the importance of prompt and

appropriate management in saving lives from

PPH
◦ Define PPH
◦ List the causes and risk factors for PPH
◦ Discuss the steps taken in managing PPH
 Bleeding >500 ml after childbirth
 Pad or cloth soaked in less than 5 minutes
 Constant trickling of blood

OR

 Delivered outside health center and still

bleeding
 Call for extra help
 Massage uterus until it is hard and give
OXYTOCIN 10 units IM
 Place cupped palm on uterine fundus and feel for
state of contraction
 Massage fundus in a circular motion with cupped
palm until uterus is well contracted
 When well contracted, place fingers behind fundus
and push down in one swift action to expel clots
 Measure/estimate blood loss and record
 Give IV fluids with 20 units oxytocin at 60
drops per minute
 Empty the bladder: catheterize if necessary
 Check and record BP and pulse every 15
minutes
 Establish cause of bleeding
 Uterine atony
 Tears of the cervix, vagina, or perineum
 Retained placenta
 Retained placental fragments
 Inverted uterus
 Ruptured uterus
 When uterus is hard, deliver placenta by
controlled cord traction
 If unsuccessful and bleeding continues –
perform vaginal examination (check if
placenta is in the cervix). Remove placenta
carefully and check if complete.
 Massage uterus
 If unable to remove placenta – REFER urgently
to hospital
 During transfer, continue IV fluids with 20
units oxytocin at 30 drops/minute
 Check placenta
 If placenta complete
◦ Massage uterus to express any clot
◦ If uterus remains soft, give OXYTOCIN 10 units IM
◦ Continue IV fluids with 20 units Oxytocin at 30
drops/min
◦ Continue uterine massage until it is hard
 Placenta is not complete or not available for
inspection
◦ Remove placental fragments by hand.
◦ If bleeding continues after fragments removed,
refer woman urgently to hospital
 Placenta is complete and vaginal bleeding
continuous:
◦ Check for uterine atony
◦ Check for trauma
 Massage the uterus until it is well contracted
 Give oxytocin
◦ Initial dose: 10 IU IM/IV or 20 IU IV infusion in 1
liter saline, 60 drops per minute
 Continuing Dose
◦ IM/IV repeat 10 IU after 20 minutes if heavy
bleeding persists OR
◦ 10 IU IV infusion in 1000 ml of saline, 30 drops per
minute.
 ERGOMETRINE – 1st line treatment of uterine
atony not responsive to oxytocin
 Rapid onset of action (2-5 min) after IM
injection
 Clinical effect persists for approximately 3
hours
 Initial dose: 0.2 mg IM/IV slowly
 Continuing dose: 0.2 mg IM after 15 minutes
if bleeding persists (up to 5 doses=1.0 mg)
 DO NOT GIVE IF PATIENT IS HYPERTENSIVE,
or has heart disease
 Monitor BP and PR
 Common side effects: nausea, vomiting,
dizziness
 Store at temperatures below 8°C and away
from light
 Point of compression is just
above the umbilicus and to the left

Bimanual compression of
AORTIC COMPRESSION
uterus
If uterus contracted and still
bleeding:

 Look for perineal, vaginal or cervical

lacerations
 Determine degree and extent of tear
 If 3rd degree tear – REFER to CEMONC
facility
 For other tears – apply pressure over tear
with sterile pad or gauze and put legs
together. Do not cross the ankles.
 Check after 5 minutes. If bleeding persists –
repair the tear.
Giving birth should be about giving
life not giving up a life.