Hemorrhage Risk Assessment
Check all applicable risk factors.
Evaluate for risk factors on admission, throughout labor, first 24 hours postpartum, and at every hand off.
Low Risk
 No previous uterine incision
Medium Risk
 Prior cesarean birth or uterine
surgery
 Multiple gestation
 Polyhydramnios
High Risk
 Placenta previa, low lying placenta
 Less than or equal to 4 previous
vaginal births
 Greater than 4 previous vaginal
births
 Hematocrit less than 30% AND
other risk factors present
 No known bleeding disorder
 No history of PPH
 Chorioamnionitis
 History of previous PPH
 Large uterine fibroids or abnormal
uterine anatomy
 Platelets less than 100,000
 Active bleeding
 Known coagulopathy
 Singleton pregnancy
 Suspected
percreta
placenta
accreta
Plan of Care
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Low Risk
Type & Screen
If prenatal antibody screen positive
(except low level anti-D from
Rhogam) – Type & Crossmatch 2
units PRBCs
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Medium Risk
Type & Screen
Review Hemorrhage Protocol
Identify women who may decline transfusion
 Notify OB provider for plan of care
 Early consult with anesthesia
 Review refusal of blood products protocol/consent form
OK PPHMP (2015)
Visit http://www.opqic.org
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High Risk
Notify OB provider, anesthesia,
charge nurse, surgery
Type & Crossmatch 2 units
PRBCs per order
Review Hemorrhage Protocol
or
Initial Post Delivery Hemorrhage Risk Assessment
Check all applicable risk factors.
Notify care provider of worsening assessment. More than one medium risk factor moves patient into High Risk category.
Evaluate for risk factors on admission, throughout labor, first 24 hours postpartum, and at every hand off.
Low Risk
 Singleton pregnancy
 No known bleeding disorder
 No history of PPH
 Uncomplicated vaginal delivery
 No genital tract trauma
Low Risk
Post Delivery Plan of Care
 Routine recovery
 Ongoing Quantitative Evaluation of
Blood Loss
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Medium Risk
Cesarean birth or uterine surgery
Multiple gestation
Polyhydramnios
Chorioamnionitis
History of previous PPH
Large uterine fibroids or uterine
anomaly
Prolonged oxytocin use
Rapid labor
Application of forceps or vacuum
Genital tract trauma
Shoulder dystocia
Magnesium Sulfate treatment
Medium Risk
High Risk
 Hematocrit less than 30% AND
other medium or high risk factors
present
 Known coagulopathy
 Active bleeding
 Platelets less than 100,000
Routine recovery with heightened
awareness for bleeding
Ongoing Quantitative Evaluation of
Blood Loss
Type & Screen
Review Hemorrhage Protocol
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High Risk
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Post Recovery Plan of Care : First 24 hours
 If initial post recovery
assessment is Low Risk,
reassess every 8 hours or more
often as condition necessitates.
OK PPHMP (2015)
Visit http://www.opqic.org

Reassess bleeding and fundus
every 4 hours or more often as
condition necessitates

Routine recovery with heightened
awareness for bleeding
Ongoing Quantitative Evaluation of
Blood Loss
Notify OB provider, anesthesia,
charge nurse, surgery
Type & Cross match 2 units
PRBCs
Review Hemorrhage Protocol
Reassess bleeding and fundus
every 4 hours or more often as
condition necessitates