11.5.1  Uterotonic drugs and IV fluids to manage atonic PPH

If the mother is bleeding heavily, while you are waiting for the emergency transport, give her a second dose of oxytocin 10 IU by intramuscular injection, or a second dose of misoprostol 400 µg rectally (by pushing the tablets gently into the rectum through the woman's anus), or by putting the tablets under her tongue where they can slowly dissolve. Do not give additional misoprostol if oxytocin was the drug used originally.

Do not exceed 1,000 µg of misoprostol! If you gave 600 µg orally straight after the baby was born, the second dose should be no more than 400 µg rectally.

If you have been trained to do so, begin pre-referral infusion of intravenous (IV) fluids to prevent and treat shock. Infuse Normal Saline 9% or Ringer’s Lactate solution, set with the fastest possible flow rate. Ensure that the bag of IV solution is held higher than the woman’s head all the time, including when she is being transported to the nearest health facility.

You learned the principles of IV fluid infusion in Study Session 22 of the Antenatal Care Module and your practical skills training.

11.5  Emergency management of postpartum haemorrhage

11.5.2  Use two-handed pressure on the uterus