Postpartum hemorrhage

Causes

1. Uterine atony
   1. Retained placental fragments
2. Lower genital tract lacerations
3. Uterine rupture
4. Uterine inversion
5. Hereditary coagulopathy

Management

1. Fluid resuscitation
2. Consider Blood Products for Hemodynamic Instability
3. Treat underlying cause:
   1. Uterine atony:
      1. Bimanual Massage
      2. Oxytocin (Pitocin) 10mg IM or slow IV push (rapid administration may cause hypotension)
      3. Misoprostol (Cytotec) 600mcg SL
      4. Methylergonovine (Methergine) 0.2mg IM (contraindicated in pts with HTN or Preeclampsia)
      5. Carboprost (Hemabate) 250mcg IV (avoid in pts with HTN or asthma)
   2. Uterine inversion:
      1. Manually replace placenta:
         1. Place hand inside the vagina and push the fundus cephalad along long axis of vagina

See Also

• Post-Partum Emergencies
• Vaginal Bleeding (Main)