11.6  A checklist for emergency referral

Finally, as we come to the end of this Module on Labour and Delivery Care, Table 11.1 summarises some key points to remember during emergency referral for postpartum haemorrhage, or any of the other life-threatening emergencies described in earlier study sessions. In the next Module, the continuum of care moves forward to the conduct of Postnatal Care.

Table 11.1  Important activities during transfer of the woman to a hospital.
Aim to maintain:Actions

Contraction of the uterus

Apply gentle uterine massage, or two-handed compression of the uterus, and maintain this during referral

Empty bladder

If the woman cannot urinate, insert a self-retaining catheter to drain the bladder and leave it in place during referral

Adequate blood volume

If the woman is haemorrhaging or in shock, administer intravenous fluids and maintain the infusion during referral

Vital signs

Check colour, pulse, blood pressure, temperature, blood loss, level of consciousness


Cover the woman with blankets


The woman should lie flat, but with her legs raised above the height of her head to help maintain her blood pressure


Give the woman your emotional support and reassurance; keep her as calm as possible

Accurate records and referral note

Write down all your findings and the interventions you are making on the referral note, with the woman’s history and identification details
  • What are the two most important points to remember about PPH?

  • You should remember that:

    • Although some risk factors are associated with PPH, two thirds of women who develop PPH have no known risk factors. Which women will develop PPH is therefore highly unpredictable.
    • Because of this you need to be alert to the possibility of PPH for every woman in your care who gives birth. And because PPH is life-threatening you must be ready to take appropriate emergency action, including getting her as quickly as possible to a health facility.

11.5.3  Emergency management for traumatic PPH

Summary of Study Session 11