This document outlines the guideline details for managing Primary Postpartum Haemorrhage. (PPH)

See Reference Maternity E Handbook Postpartum Haemorrhage (PPH) - prevention, assessment and management in the references section.

The Obstetric Consultant is to be informed if the blood loss is greater than 1 litre.

At Grampians Health Ballarat, 1st line medication management for 3 stage is Syntometrine 1ml IM unless the women have a history of hypertension then Syntocinon 10 iu IM is given.

Weighed Blood Loss

All births are required to have weighed blood loss.

Born Before Arrival

Mothers who birth at home and come to the hospital via an ambulance, are to be reviewed in the emergency department by the Obstetric team before transferring to the ward, to ensure the woman does not need immediate PPH management.

Carbetocin

At Grampians Health Ballarat first line medication for third stage for caesarean section is IV Carbetocin.

When Carbetocin is used, if there is a PPH (EBL >500ml), there is no benefit to giving Syntocinon infusion or Syntocinon bolus.

Instead, other medications such as Ergometrine should be used (in the absence of contraindications).

Carboprost

When Carboprost is given on the ward, there must be a decision to go to theatre due to the short onset/short offset action of the medication.

PPH Risk Assessment

On admission all women have a PPH risk assessment completed - Refer to Appendix 1 and Appendix 4

PPH risk is reassessed intrapartum and documented on the Partogram - Refer to Appendix 4

PPH risk is discussed and documented pre-theatre - Refer to Appendix 5

At Grampians Health Ballarat if PPH risk management requires IVC, 18g cannula can be used. If a PPH occurs, and IVC is required ideally a 16g cannula should be inserted.

PPH Consumer Information

Refer to:

• Appendix 2 Postpartum Haemorrhage Things to consider during your pregnancy.

• Appendix 3 Postpartum haemorrhage Explaining your treatment.

Consumer information to be given at an antenatal appointment and following the occurrence of a PPH following birth.

(Acknowledgement to the Royal Woman's Hospital for the CID. The Royal Woman's Hospital PPH CID is deemed as best practice.)