How is a protocol for management of postpartum hemorrhage (PPH) implemented?

Updated: Jun 27, 2018
  • Author: John R Smith, MD, FACOG, FRCSC; Chief Editor: Ronald M Ramus, MD  more...
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Patients with PPH require aggressive measures to restore and maintain the circulating blood volume (and thereby perfusion pressure) to vital structures. All medical units involved in the care of pregnant women must have a protocol for the management of severe obstetric hemorrhage. [30] Management of massive obstetric hemorrhage outlines such a protocol for a pregnant woman in either the antepartum or postpartum period. [31] Implement the protocol in a manner similar to a cardiac arrest protocol, with the same attention to detail and documentation. Just as with other advanced life support protocols, conduct periodic reviews and practice drills.

The diagnosis of PPH is established by observing the amount of bleeding and the patient’s clinical status. The amount of blood lost and the patient’s level of consciousness and vital signs are continually assessed. Once the diagnosis is made, immediately notify appropriate staff members. The magnitude and underlying cause of the bleeding to some degree dictate which specialized personnel are called, but a minimum of 1 obstetrician and 1 anesthetist is necessary. Skilled midwives or nurses can be indispensable. Notifying blood transfusion services is essential because the timely availability of blood products is likely to be critical. As in a cardiac arrest, designate an experienced person to document critical information and times. Ensure the availability of an operating room. The speed with which PPH occurs, becomes life-threatening, and can be successfully managed with relatively simple interventions sometimes makes it difficult to decide when to institute the full protocol.

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