Major Obstetric Haemorrhage Flashcards
- What is the first thing you should do when you notice a haemorrhage?
Call for help and pull the emergency buzzer
- Which people should attend?
Senior midwife Experienced obstetrician Experienced anaesthetist Experienced neonatologist Additional support staff
- Who should be on standby?
Haematologist
Blood bank technician
Theatre staff
Porter
- Which position should you place the woman in?
Left lateral
- What is the next thing you should do?
Give high-flow oxygen with a non-rebreath mask
- What observations should be taken?
Pulse Blood pressure Capillary refill Respiratory rate Oxygen saturation
- How often should observations be taken?
Every 5 minutes
- What size cannulae should be sited?
x2 grey 16 gauge large bore cannulae
- What urgent bloods should be taken?
FBC Clotting screen (including fibrinogen) Kleihauer group and save cross-match 4 units
- How much IV fluid for fluid resuscitation be given?
2 litres warmed crystalloid like Hartmanns or 0.9% saline
- How should you assess where the blood loss is coming from?
Use the 4 Ts Tone (uterine atony) Tissue (retained products) Trauma Thrombin (coagulopathy)
STOP THE BLEEDING
What drugs should you administer?
Syntocinon 10 units or
Ergometrine 500 mcg
IM or slow IV injection
(ergometrine contraindicated if raised BP)
Next drug?
Syntocinon infusion
40 units syntocinon IV infusion via pump over 4 HOURS
Drugs for bleeding
Tranexamic acid 1 g (100mg/mL) given as slow intravenous injection (at rate of 1mL/minute) Repeat after 30 minutes if PPH continues
Urine output?
Site urinary catheter with urometer
Empty bladder and monitor urine output hourly
Any other drugs
Carboprost
250mcg given IM every 15 minutes up to 8 doses
Any other drugs
Misoprostal
800 mcg given PR
(Most for use when refrigerated uterotonics are unavailable)
