| 1 |
Continue
to massage the uterus. |
| 2 |
Use
oxytocic drugs which can be given together or sequentially.
|
Do
not give prostaglandins intravenously. They may be fatal.
|
| 3 |
Anticipate
the need for blood early and transfuse as necessary. |
| 4 |
If
bleeding continues:
| • |
Check
the placenta again for completeness |
| • |
If
there are signs of retained placental fragments
(absence of a portion
of maternal surface or torn membranes with vessels), remove remaining
placental tissue |
| • |
Assess
clotting status using a bedside clotting test;
failure of a clot to form
after 7 minutes or a soft clot that breaks down easily suggests coagulopathy. |
|
| 5 |
If
bleeding continues in spite of management above:
| • |
Perform
bimanual compression of the uterus (Figures 12.2,
12.3) and maintain compression until bleeding is controlled and the uterus
contracts |
| • |
Alternatively,
compress the aorta (Figure
12.4). |
|
|
|
|
| 6 |
If
bleeding continues in spite of compression, perform uterine
and uteroovarian artery ligation; if life-threatening
bleeding continues after ligation, perform subtotal hysterectomy. |
