It may be :
• Vaginal bleeding is excess of 500ml child birth is defined as PPH
• Primary PPH (immediate PPH) : Increased vaginal bleeding with in first 24 hr of child birth.
• Secondary PPH (delayed PPH) : Increased Vaginal bleeding following the first 24 hours
after child birth
Causes Primary PPH :
• 4 Ts
- 'T' = Tone Atonic uterus
- 'T' = Tissue retained (retention of placental tissue in uterus or retention of fetal membrane)
- 'T' = Tear: injuries to genital tract ( valve, vagina, cervix and uterus0
- 'T' = Thrombin
Note: Bleeding may occur at a slow rate over several hours, the condition may not be recognized
until the women suddenly enter shock.
Prevention of PPH:
• Inj Oxytocin 10 unit IM
• Controlled cord traction
• Uterine massage
• Tab Misoprostol 600 micro gram ( in case of home delivery immediately after delivery of
baby before delivery of placenta)
Management of primary PPH:
• Inj. Oxytocin 10 unit IM stat. and continuing doses: IV 20 unit in 1 lit. IV fluid at 60 drops/
min. maximum dose: not more than 3 lit. of IV fluid containing oxytocin. Do not give as in
IV bolus.
• Monitor of blood pressure and pulse rate
• Intravenous infusion of inj. R/L or N/S
• Massage the uterus.
• Bladder empty.
• Bimanual compression.
• If uterus well contracted and bleeding continues, examine the genital tract for tear.
• Bed side clotting test.
• Refer to higher center as soon as possible.
Management of secondary PPH (Supportive therapy ):
• Start IV line
• Bed rest .
• Hb% , Grouping , and cross matching .
• Start blood in referral place .
• 10 unite oxytocin I/M
• Start antibiotics :
• Ampicillin 1g1/V or 1/M6 hourly plus
• Gentamicin 5 mg/kg body weight.
• Metronidazole 500 mg I/V 8 hourly .
• Assess the condition and manage appropriately
• If condition not improved refer.
Source :STANDARD TREATMENT PROTOCOL FOR HEALTH POSTS AND SUB HEALTH POSTS 2070
