Postpartum Hemorrhage Management

Management of Postpartum Hemorrhage Due to Uterine Atony

• Postpartum hemorrhage is defined as estimated blood loss of 2,000 mL or more, or any bleeding accompanied by hypovolemia.
• Uterine atony presents with a soft, boggy uterus, indicating the need for immediate intervention.

Step-by-Step Management

• Step 1: Uterine Massage & Oxytocin

  • Initiate uterine massage to stimulate contraction.
  • Administer high-dose oxytocin to promote uterine tone.

• Step 2: Tranexamic Acid

  • Utilize tranexamic acid to aid in reducing blood loss through antifibrinolytic action.

• Step 3: Second-Line Uterotonic Agents

  • Methylergonovine: Effective uterotonic but contraindicated in patients with hypertension.
  • Carboprost Tromethamine: Another uterotonic option, contraindicated in individuals with asthma.
  • Misoprostol: Can be used as a uterotonic agent with various routes of administration.

• Step 4: Intrauterine Balloon Tamponade

  • Implement an intrauterine balloon tamponade as a mechanical method to control bleeding.

• Step 5: Laparotomy

  • Consider laparotomy in cases where bleeding remains uncontrolled after all conservative measures have been attempted.

Contraindications

• Methylergonovine and carboprost tromethamine have specific contraindications that must be addressed before administration.