What is the focus of clinical history for postpartum hemorrhage (PPH)?

Updated: Jan 02, 2018
  • Author: Maame Yaa A B Yiadom, MD, MPH; Chief Editor: Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE  more...
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Answer

The clinical history should be taken as a primary survey (ABCs) of the patient. This should include collecting an initial set of vital signs to guide the patient’s management, as the patient is positioned to begin the physical examination. Keep in mind, that if the bleeding is very brisk, the patient’s mental status may wane. As a result, this first set of questions should include queries about signs and symptoms that are most crucial in managing potential circulatory collapse, identifying the cause of postpartum hemorrhage (PPH), and selecting appropriate therapies. [10]

Severity of bleeding

Consider the following:

  • Is the placenta delivered?

  • What has been the duration of the third stage of labor?

  • How long has the bleeding been heavy?

  • Was initial postdelivery bleeding light, medium, or heavy?

  • Are symptoms of hypovolemia present such as dizziness/lightheadedness, changes in vision, palpitations, fatigue, orthostasis, syncope or presyncope?

  • If evaluating a patient with delayed postpartum hemorrhage, what has been the bleeding pattern since delivery?

Intervention guides

Obtain the following information:

  • Is there a history of transfusion? What was the reason for transfusion? Is there a history of a transfusion reaction?

  • Past medical history (particularly cardiovascular, pulmonary, or hematologic conditions)

  • Allergies

Predisposing factors and potential etiology

Obtain the following information:

  • History of postpartum hemorrhage

  • Gravity, parity, length of most recent pregnancy, history of multiple gestations

  • Number of fetuses for the most recent pregnancy

  • Pregnancy complications (polyhydramnios, infection, vaginal bleeding, placental abnormalities)

  • If the placental was delivered, was it spontaneous, or was manual delivery required?

  • Current and past history of vaginal delivery versus cesarean delivery

  • If cesarean delivery, was it planned in advance, decided upon after a failed vaginal delivery attempt, or performed emergently?

  • Other uterine surgeries such as myomectomy (transvaginal vs transabdominal), uterine septum removal

  • Personal or family history of bleeding disorder

  • Medications such as prescribed, over the counter, diet supplements, or vitamins (with particular attention to anticoagulants, platelet inhibitors, uterine relaxants, and antihypertensives)

  • Vaginal penetration since delivery (tampons, finger, other foreign object, vaginal intercourse)

  • Signs or symptoms of infection such as uterine pain or tenderness, fever, tachycardia, or foul vaginal discharge

  • Information helpful for continued management

  • When and where was the delivery?

  • Who assisted the delivery?

  • Where and with whom was prenatal care?

  • Healthy infant(s) delivered (any complications or concerns before, during, or after delivery)?

  • Past surgical history


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