Episode 36: Tackling Postpartum Hemorrhage in the ER Featuring Dr. Shorok Hassan, Dr. Danielle Langan, & Annie Taffaro MS4 

Written By The Administrator

Learning Objectives

1. ACOG defines PPH as ≥ 1,000 mL blood loss OR any blood loss causing hypovolemia within 24 hrs postpartum. It is still a leading cause of maternal mortality worldwide

2. The 4 main etiologies of PPH are organized by the 4 T’s: Tone (uterine atony); Tissue (retained placenta/products); Trauma (lacerations or surgical injuries) and Thrombin or coagulopathies (Amniotic fluid embolism, placental abruption, HELLP, inherited disorders)

3. Treat Tone and Tissue Early with fundal massage, uterotonics and bimanual exam to remove any retained tissue products.

Uterotonic dosages as follows:  

  • Oxytocin: 10U IM or 10-40U in 1L of normal saline/lactated ringers infused rapidly

  • Cytotec (misoprostol): 600-1000mcg per rectum

  • Methergine: 0.2 mg IM, repeat every 2–4 hours

  • Carboprost or hemabate: 250 mcg IM every 15–90 minutes with max dose of 2mg

4. Escalate care by activating a massive transfusion protocol liberally and in coordination with OB/GYN services.

5. Know what mechanical interventions are available in the ED (Bakri balloon, Jada device) and know when surgical options may come into play if initial measures fail. 

The Administrator
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Critical Care Casebook Episode 3: Pulmonary Embolism