Management
Immediate Measures
- Call for extra help
- Open IV channel by 2 wide bore cannula
- Send blood for grouping, cross-matching & coagulation screening
- Ask for blood (at least 2 units) & transfuse when available
- Give IV fluid (Hartmann solution) till blood is available
- Catheterization to monitor urine output
- Monitor pulse, BP, temperature, and urine output every 15-30 minutes
- Tranexamic acid
Find out the Cause
Feel the uterus by abdominal palpation:
- Soft & flabby → Atony
- Hard & contracted → Traumatic
Specific Management (Atony)
- Infuse 1L Hartmann solution with 20 IU oxytocin within 15 minutes, next 1L within 30 minutes
- Ergometrine 0.2mg IV/IM
- Bimanual compression
- Exploration of the uterine cavity
- Intrauterine balloon tamponade (condom tamponade)
- External aortic compression
- Surgery:
- B-Lynch method
- Uterine artery ligation
- Ovarian artery ligation
- Hysterectomy
Specific Management (Traumatic)
- Exploration
- Identify bleeding site
- Repair of the tear