
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
uterus
AORTIC COMPRESSION
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.