Blood loss ≥500 mL after vaginal birth or ≥1000 mL after caesarean, or any loss causing haemodynamic compromise.
Causes
- • Tone — uterine atony (70%)
- • Trauma — tears, uterine rupture
- • Tissue — retained placenta
- • Thrombin — coagulopathy
Management
- • Call for help, two large-bore cannulae, cross-match, major haemorrhage protocol
- • Uterine massage and bimanual compression, empty bladder
- • Oxytocin 5 IU IV then infusion; ergometrine; carboprost; misoprostol
- • Tranexamic acid 1 g IV within 3 h (WOMAN trial)
- • Balloon tamponade → B-Lynch suture → uterine artery ligation → hysterectomy
Clinical pearls
- • Underestimation of loss is universal — weigh swabs
- • Recheck for a fourth-degree tear and retained products when tone is good but bleeding continues
Related in WardRound
Educational — verify locally.
