Postpartum haemorrhage

Summary of changes

Addition 

  • POCT Hb, Chem8/CG4 and INR 4
  • Non-pneumatic anti-shock garment added if available
  • Medical consult re administration of IV fluid to minimise risks of dilutional coagulopathy

Deleted

  • Delayed breastfeeding — as it is not a cause of atonic uterus
  • The most common physiological cause is an overdistended uterus: long labour, multiple pregnancy, also previous pot-partum haemorrhage

Medicines

  • Tranexamic acid IV administration added to flow chart

Primary references

  1. Belfort MA (2021) Overview of postpartum hemorrhage, UpToDate, accessed 1 April 2022.

  2. Belfort MA (2021) Postpartum hemorrhage: medical and minimally invasive management, UpToDate, accessed 1 April 2022.

  3. Queensland Clinical Guidelines (2021) Primary postpartum haemorrhage, Maternity and Neonatal Clinical Guideline, accessed 11 January 2022.

  4. Royal Australian and New Zealand College of Obstetricians and Gynaecologists (2020) PROMPT – Practical Obstetric Multi-Professional Training: course manual, Australian and New Zealand edition, Cambridge University Press, Cambridge.

  5. Royal College of Obstetricians and Gynaecologists (2017) 'Prevention and management of postpartum haemorrhage (Green-top Guideline No. 52)', British Journal of Obstetrics and Gynaecology, 124(5):e106-e149, doi:10.1111/1471-0528.14178

  6. South Australian Maternal, Neonatal and Gynaecology Community of Practice (2021) Blood Transfusion and Massive Blood Transfusion (Perinatal), SA Perinatal Practice Guidelines, accessed 11 January 2022.

  7. South Australian Maternal, Neonatal and Gynaecology Community of Practice (2013) Postpartum Haemorrhage, SA Perinatal Practice Guidelines, accessed 11 January 2022.

  8. WOMAN Trial Collaborators (2017) 'Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial', The Lancet, 389(10084):2105-2116, doi:10.1016/S0140-6736(17)30638-4

  9. World Health Organization (2021) WHO Model List of Essential Medicines, Version 22, World Health Organisation, Geneva, accessed 30 January 2022.