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Postpartum Hemorrhage, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Postpartum hemorrhage (PPH) after 20 wk gestation

  • Primary: Hemorrhage occurring ≤24 hr after delivery

    • Also known as early PPH

  • Secondary: Hemorrhage occurring >24 hr after delivery (b...

Diagnosis

Signs and Symptoms

  • Ongoing blood loss, usually painless

  • Significant hypovolemia, resulting in:

    • Tachycardia

    • Tachypnea

    • Narrow pulse pressure

    • Decreased urine output

    • Cool, clammy skin

    • Poor capillary ref...

Treatment

  • Patients with PPH may be hemodynamically unstable

  • IV access, and active resuscitation is important, considering both crystalloid and blood product resuscitation and closely following BP and m...

Follow-Up

Disposition

Admission Criteria

  • All patients with immediate PPH require admission to a closely monitored setting

  • Early obstetrics consultation is recommended

  • Early surgical intervention is depend...

Pearls and Pitfalls

  • Active over expectant management

    • Most deaths are due to delayed diagnosis and/or inadequate resuscitation with blood products

  • Uterotonics are the first line of treatment

  • Aggressive us...

Additional Reading

  • Cabero Roura  L, Keith  LG. Post-partum haemorrhage: Diagnosis, prevention and management. J Matern Fetal Neonatal Med.  2009;22(suppl 2):38–45.

  • Hofmeyr  GJ, Gülmezoglu  AM. Mis...

Codes

ICD9

  • 666.00 Third-stage postpartum hemorrhage, unspecified as to episode of care or not applicable

  • 666.10 Other immediate postpartum hemorrhage, unspecified as to episode of care

  • 666.20 Delayed and...

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