What is the initial emergency department (ED) evaluation of 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 patient with suspected or obvious postpartum hemorrhage should be managed like any other hemorrhaging patient. Resuscitation measure should be started with the history and physical examination according to acute life support algorithms. Have someone call a consultant obstetrician/gynecologist (OB/GYN) immediately as care for the patient is initiated in order to make the patient's transition from resuscitative care to definitive care with the OB/GYN team smooth and early.

Primary survey (ABCs)

Perform the irway assessment evaluating it for patency. Assess reathing adequacy and provide supplementation with 100% oxygen as needed. Assess the C irculatory status (including peripheral pulses, heart rate, blood pressure, and a perineal examination). Support circulation to vital organs by putting the patient into the Trendelenburg position, placing at least 2 large-bore IVs, starting a rapid crystalloid infusions through both IVs, and establishing continuous vital sign monitoring to guide continued management.


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