OG16.2 | PPH Emergency Techniques — Summary & Reflection

KEY TAKEAWAYS

PPH emergency techniques are second-line mechanical and physical interventions applied when uterotonic therapy is insufficient, as bridges to surgical management or definitive transfer. The three principal non-surgical techniques are:

1. Bimanual uterine compression — internal hand in anterior fornix + external hand on fundus, compressing the uterine body; maintained ≥20–30 min; concurrent with uterotonics. Aortic compression (fist at umbilical level pressed posteriorly) is a simultaneous bridge for catastrophic haemorrhage.

1. Intrauterine balloon tamponade — Bakri balloon or condom catheter (300–500 mL warm saline) inflated in the uterine body. Tamponade test: positive (bleeding stops) = surgery avoided in ~80%; negative (bleeding continues) = proceed to surgery.

1. NASG — neoprene circumferential compression applied distal to proximal (legs → thighs → pelvis → abdomen); pelvic ball over symphysis pubis. Reduces blood loss 40–50%, autotransfuses peripheral blood centrally; bridge to transfer or surgery.

Key rules: apply mechanical techniques concurrently with uterotonics, not instead of them; assess response at defined time points; make the escalation decision decisively.

REFLECT

Consider: in a district hospital with no blood bank and a 90-minute transfer time to a tertiary centre, which of the three techniques described in this module would you prioritise assembling and deploying first, and why? Think about the skill required, the resources needed, the time to assemble, and the likely effectiveness for the most common cause of PPH. Write your answer before discussing with your clinical supervisor. Kolb's active experimentation phase asks you to plan how you would apply these skills in the specific settings you are likely to work in during your internship — a rural primary health centre, a district hospital, or a medical college — and to identify what equipment each would realistically have available.