Admission Hemorrhage Risk Assessment
Check applicable risk factors.
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
 No known bleeding disorder
 No history of PPH
 BMI less than 30
 Chorioamnionitis
 History of previous PPH
 Large uterine fibroids or abnormal
uterine anatomy
 Estimated fetal weight 4000 gm or
greater
 BMI greater than 30
 Hematocrit less than 30% AND
other medium or high risk factors
present
 Platelets less than 100,000
 Anticoagulant therapy
 Known coagulopathy
 Singleton pregnancy
 Suspected placenta accreta
 Active bleeding
Plan of Care

Low Risk
Consider Type & Screen
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Medium Risk
Type & Screen
Review Hemorrhage Protocol
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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 (2013)
Visit http://www.oumedicine.com/OBGYN/outreach/opqi
High Risk
Notify OB provider, anesthesia,
charge nurse, surgery
Type & Cross match 2 units
PRBCs per order
Review Hemorrhage Protocol
Initial Post Delivery Hemorrhage Risk Assessment
Check applicable risk factors
Notify care provider of worsening assessment. More than one medium risk factor moves patient into High Risk category.
Low Risk
 Less than 5 total vaginal births
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
 No known bleeding disorder
 No history of PPH
 Uncomplicated vaginal delivery
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 No genital tract trauma
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 Singleton pregnancy
Low Risk
Post Delivery Plan of Care
 Routine recovery
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Medium Risk
Cesarean birth or uterine surgery
Multiple gestation
Polyhydramnios
Greater than or equal to 5 total
vaginal births
Chorioamnionitis
History of previous PPH
Large uterine fibroids or uterine
anomaly
Prolonged active labor > 12 hr.
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
 Platelets less than 100,000
Routine recovery with heightened
awareness for bleeding
Consider Type & Screen
Review Hemorrhage Protocol

 Anticoagulant therapy
 Known coagulopathy
 Active bleeding
High Risk
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Post Recovery Plan of Care : First 24 hours
OK PPHMP (2013)
Visit http://www.oumedicine.com/OBGYN/outreach/opqi
Routine recovery with heightened
awareness for bleeding
Notify OB provider, anesthesia,
charge nurse, surgery
Consider Type & Cross match 2
units PRBCs per order
Review Hemorrhage Protocol

If initial PP assessment is Low
Risk, reassess every 8 hours or
more often as condition
necessitates.
OK PPHMP (2013)
Visit http://www.oumedicine.com/OBGYN/outreach/opqi

Reassess bleeding and fundus
every 4 hours or more often as
condition necessitates

Reassess bleeding and fundus
every 4 hours or more often as
condition necessitates