There are two key aspects to management;
1. Immediate resuscitation
2. Identification of the cause
Resuscitation includes an ABCDE assessment with;
2x large bore cannulae FBC/clotting/G+S
IV fluids Blood transfusion
§Uterine atony;
Palpate and rub the uterus
Empty the bladder
IV syntocinon infusion (40 units in 4 hours)
§Lower genital tract injury;
Examine lower genital tract in lithotomy position
Suture any visible injury
If unable to control insert vaginal pack
§Retained placenta;
Failure to expel all of the placenta by 30 minutes
Prevents uterine contraction and #bleeding
Commence syntocinon infusion
Transfer to theatre for manual delivery
Requires stat dose of IV abx
§Other methods of stopping bleeding;
Suture placental bed Balloon tamponade
B-Lynch suture Uterine artery ligation