3.1.2  Pre-referral management of PPH

You should remember that any amount of active (fresh or bright red) vaginal bleeding after 24 hours may be due to one of the causes listed in Box 3.1, or others not mentioned. Therefore, you should refer these women to a hospital regardless of the amount of bleeding. You should also remember that if the bleeding is severe, only a blood transfusion can save the life of the mother.

The more detailed management of PPH was taught in Study Session 11 of the Labour and Delivery Care Module and described in Study Session 22 of the Antenatal Care Module, as well as in your practical skills training.

  • What did these study sessions tell you to do before referring a women with PPH?

  • An injection is administered to a woman who has PPH.
    Figure 3.2  Inject 10 IU of oxytocin (or give 400 micrograms misoprostol) before referring a woman with PPH.

    Put up an intravenous (IV) line, and start the woman on intravenous fluid therapy with Ringer’s Lactate or Normal Saline, using a 1,000 ml (1 litre) bag and a flow rate set to run as fast as possible.

As a pre-referral treatment, you should also give her a second dose of misoprostol (400 micrograms orally or rectally), or oxytocin 10 IU (International Units) by intramuscular injection (Figure 3.2).

3.1.1  Causes of late postpartum haemorrhage

3.2  Puerperal sepsis and fever