500mL/min

compared to 50mL/min non-pregnant

(i.e. 10x normal blood supply in pregnancy)

1. What is the average post-partum loss?
2. Define primary post-partum haemorrhage.

1. 300-500mL - BUT tends to be underestimated
2. >500mL post-vaginal delivery; >1000mL post-C/S within the first 24 hours

• multiparity
• previous PPH
• uterine distension (e.g. multiple gestation/polyhydramnios/LGA)
• prolonged labour/instrumental delivery
• uterine abnormalities, e.g. fibroids
• antepartum haemorrhage
• use of Syntocinon in labour
• placenta previa
• sepsis

• Antepartum Hb/iron checks +/- supplements
• Group & save
• Fluid management during labour
• Active management of 3rd stage
  • IM Syntocinon
  • controlled cord traction & placenta delivery
• Fundal massage
• Check placenta for completeness
• Check perineum & vagina for trauma

Higher risk: put in cannula & IV fluids

Tone: uterine atonia

Tissue: retained tissue

Trauma: to the birth canal

Thrombin: bleeding disorder

1. Call for help! Notify OT & anaesthetist
2. Crossmatch, FBC, coagulation study
3. IDC
4. Fundal massage
5. Fluid management

• Oxytocin: quick onset, short t_1/2 (3-4 min), ADH-like effect
• Ergometrine: longer til onset, longer t_1/2, vasoconstrictive & bronchospasm effect
• Prostaglandins: potent, injected myometrially, bronchospasm, hypertension, vomiting common
• Misoprostol: prostaglandin, slow onset, cheap, easy administration

1. ABC!
2. Urgent transfer to theatre
3. Blood transfusion
4. Bimanual compression
5. Inform/consent patient re: possible hysterectomy

• operative complications (e.g. renal tract damage)
• continued bleeding & coagulopathy (DIC)
• DVT
• Renal failure
• Sheehan's Syndrome
• Psychological/emotional issues