Learn various ways to manage postpartum hemorrhage: http://www.merckmanuals.com/professional/gynecology-and-obstetrics/abnormalities-and-complications-of-labor-and-delivery/postpartum-hemorrhage
Whenever blood loss is significant, call for additional personnel, give IV fluid resuscitation and test for coagulopathy. considering disseminated intravascular coagulation as well as inherited coagulopathy. Lab tests should include fibrinogen level as well as CBC with platelets, PT/PTT, and type and screen for possible transfusion. Uterine atony is the most common cause of hemorrhage. Begin with uterine massage (bimanual if necessary) and oxytocin. Consider a 2nd uterotonic drug, such as methylergonovine, 16-methyl prostaglandin F 2-alpha, or misoprostol. Assess for retained products of conception. Repair vaginal and cervical lacerations. If needed, tamponade the uterus using an intrauterine balloon or gauze packing. If bleeding persists, do a laparotomy. Do a hysterotomy to empty the uterus. Place uterine compression sutures, such as the B-Lynch or the modified B-Lynch.
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Procedure by Kate Barrett, MD and Will Stone, MD, Walter Reed National Military Medical Center Residency in Obstetrics and Gynecology; Barton Staat, MD, Uniformed Services University; and Shad Deering, COL, MD, Chair, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center Residency in Obstetrics and Gynecology; Assisted by Elizabeth N Weissbrod, MA, CMI, Eric Wilson, 2LT, and Jamie Bradshaw at the Val G. Hemming Simulation Center at the Uniformed Services University.