OG16.1 | Post-Partum Haemorrhage — Summary & Reflection

KEY TAKEAWAYS

Postpartum haemorrhage (PPH) is defined as blood loss ≥500 mL (vaginal) or ≥1000 mL (caesarean), or any haemodynamically significant loss. Primary PPH occurs within 24 hours; secondary PPH from 24 hours to 12 weeks. The four causes — the 4 T's — are Tone (atony, 70–80%), Tissue (retained placenta/membranes), Trauma (genital lacerations, rupture), and Thrombin (coagulopathy/DIC).

Prevention: Active Management of the Third Stage of Labour (AMTSL) — oxytocin 10 IU IM within 1 minute of delivery + controlled cord traction — is the most evidence-based preventive intervention, reducing PPH incidence by 40%.

Medical management escalates stepwise: oxytocin (first-line, no contraindications) → ergometrine 0.5 mg IM (contraindicated in hypertension/pre-eclampsia) → carboprost 250 µg IM (contraindicated in asthma) → misoprostol 800 µg sublingual/rectal. Tranexamic acid 1 g IV within 3 hours (WOMAN trial: reduces mortality) is a vital adjunct.

Surgical management escalates from bimanual compression → intrauterine balloon tamponade → B-Lynch suture → uterine devascularisation → obstetric hysterectomy.

Blood products: Massive transfusion protocol (PRBC:FFP:Platelets = 1:1:1); cryoprecipitate when fibrinogen <2 g/dL. The shock index (HR ÷ SBP >1.0 = compromise; >1.7 = life-threatening) guides resuscitation urgency.

REFLECT

Think about a woman you have seen in the postnatal ward or delivery suite with significant bleeding after delivery. What was the cause identified — and how was it managed? If you have not yet seen a PPH case, imagine yourself as the junior doctor on call tonight when this scenario presents: what would you say to the nursing staff in the first 2 minutes, what would you order, and who would you call? Kolb's reflective cycle asks you to move from experience (or imagined experience) through reflection, abstract conceptualisation, and active experimentation. After completing this module, write a brief mental plan — your first five actions in the first five minutes of a PPH — and discuss it with your clinical supervisor at the next bedside teaching session.