By ULY CLINIC

Postpartum Haemorrhage (PPH)

Introduction

PPH is loss of more than 500 ml of blood from the genital tract in the first 24 hours after vaginal delivery and more than 1000 ml after Caesarean section.

Prevention

The use of uterotonics for the prevention of PPH during the third stage of labour is recommended for all births. (Strong recommendation, moderate quality evidence)

Pharmacological Treatment

Oxytocin 10 IU IM

Ergometrine 0.25mg IM

Misoprostol 600μg PO start

Note

Caution should be exercised when opting for ergot derivatives for the prevention of PPH as these medicines have clear contraindications in women with hypertensive disorders. Thus, it is probably safer to avoid the use of ergot derivatives in unscreened populations
Misoprostol ( 600µg PO) is regarded an effective medicine for the prevention of PPH

Prevention of PPH – Cord management and Uterine massage

Controlled cord traction (CCT) is recommended for vaginal births
In settings where skilled birth attendants are unavailable, CCT is not recommended
Late cord clamping (performed approximately 1 to 3 minutes after birth) is recommended for all births while initiating simultaneous essential newborn care.
Sustained uterine massage is not recommended as an intervention to prevent PPH in women who have received prophylactic oxytocin.

Prevention of PPH in Caesarean sections

Oxytocin (IV or IM) is the recommended uterotonic drug for the prevention of PPH in Caesarean section
Cord traction is the recommended method for the removal of the placenta in Caesarean section

Updated on, 3.11.2020

References

1. STG

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