3 thoughts

  1. Nice one, Anna.

    As a veteran of many a PPH, I’d just add in a couple of thoughts:
    – If the patient is not bleeding much, don’t worry too much about delivering the placenta immediately. It can take a few minutes (or sometimes half an hour or more) for “separation” to occur, after which time the placenta comes away pretty easily on it’s own. If you’re pulling on the cord before then (even gently) there is an increased risk of uterine inversion or retained products. There’s generally no harm in waiting until you have obstetrics assistance before delivering the placenta.
    – Don’t check the placenta yourself – get a nurse / midwife to do it. The main doctor definitely can not afford to turn their attention from the patient for those couple of minutes.
    – Ideally you need two teams – one to resuscitate and one to do the physical treatments down below. By the time you’ve got 2 x IVC in they may have lost a litre already…
    – If there is an obvious bleeding artery in the perineum from trauma and you’re not confident with perineal suturing, buy some time by just putting an artery clip / vascular clamp on it. (This is usually the first thing I do)
    – When in doubt – the highest yield intervention is bimanual compression. You don’t have to remember any drug doses and can do that for as long as it takes to have help arrive to start thinking about all the drugs.
    – Catheterising the bladder can also help improve bleeding from atony.

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