Treatment

Call for help

Insert 2 large bore cannulas and start

IV fluid Normal saline or Ringer’s lactate 3ml / ml of blood loss.

Blood Transfusion depending on amount of blood loss. 

Oxytocin (IV) 20IU in 500mls Normal Saline, titrate at 20 drops per minute

Misoprostol (PO) 1000mcg or per rectal

Ascertain origin of bleeding

Perform uterine packing

Insert and balloon uterine tamponade

Ensure uterine contraction by Fundal palpation, Uterine massage, Bimanual uterine compression. 

Internal Pressure Occlusion of the Aorta

External pressure occlusion of aortic aorta.

 It is performed by pressing a closed fist down, just above and to the left of the umbilicus, with the intend to compress the aorta externally.

Surgical treatment

Vaginal/Perineal Lacerations repair

Uterine Artery Ligation

Internal Iliac Artery Ligation

Uterine compressional sutures such as  B-Lynch Brace Suture

Uterine repair

Hysterectomy