Friday, February 21, 2020

Post Partum Hemorrhage - Updates

Following bleeding scenarios amount to PPH under the latest WHO document
  1. Blood loss >500 mL in c/o Vaginal delivery
  2. Blood loss > 1 L in c/o C Section + in c/o twins
  3. Blood loss > 1.5 L in c/o Hysterectomy
  4. Blood loss on any case more than what is expected over a period of 24 hours

Following bleeding scenarios amount to PPH as per the latest ACOG recommendations

  1. Blood loss equal to or more than 1 L irrespective of mode of delivery
  2. Bleeding with signs and symptoms of hypovolemia

Updates in Management of PPH

  1. Uterine massage is added along with uterotonics
  2. PGE1 if given Per Rectally (not recommended), 1000 micrograms is advised
  3. Inj Tranexamic Acid is recommended in all bleeding diasthesis - 1 gram slow IV (over 20 minutes) 
  4. Mechanical Devices allowed
    1. Sengstaken Blakemore Catheter
    2. Bakri Balloon Catheter

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