Postpartum Haemorrhage & Obstetric Emergencies
Recognise major bleeding and coordinate urgent, cause-directed obstetric care.
Quick revision ↓ Medical Dictionary
01Recognise haemorrhage early
Assess bleeding objectively where possible and interpret it with pulse, blood pressure, symptoms and ongoing loss. Do not wait for a fixed volume threshold when the patient is deteriorating. Call for help and activate the appropriate haemorrhage response. Resuscitation, assessment of the cause and treatment proceed together, with clear team roles and repeated reassessment.
02Think of the cause
The four Ts organise common causes: tone, trauma, tissue and thrombin. Uterine atony is common, but genital tract injury, retained tissue and coagulation problems may coexist. A firm uterus does not exclude serious haemorrhage. Examine and investigate through the appropriate skilled pathway while treatment and blood-product support are arranged according to need.
03Initial treatment principles
Current haemorrhage care combines prompt uterine assessment and appropriate massage, uterotonic treatment, tranexamic acid, intravenous fluids and examination for the source, with escalation. Contraindications and local protocols guide drug selection. Persistent bleeding may require tamponade, surgery or other specialist measures. Do not let repeated ineffective treatment delay definitive control of the source.
04Other acute emergencies
Shoulder dystocia requires an immediate trained team response with a structured manoeuvre sequence; fundal pressure is unsafe. Cord prolapse with a viable fetus requires urgent help and expedited birth planning while trained staff reduce cord compression appropriately. These are emergencies requiring supervised skills and rehearsed local protocols rather than improvised unsupervised procedures.
05Recovery and documentation
Following major bleeding or an emergency, reassess anaemia, organ function, thrombosis risk and psychological needs. Explain what happened and document treatments, blood loss and follow-up. Consider implications for future pregnancy and provide a clear discharge plan. Recovery may require continuing support even after physiological observations have returned to normal.
High-Yield Revision
- Treat deterioration without waiting for a numerical blood-loss threshold.
- Tone, trauma, tissue and thrombin can coexist.
- Persistent bleeding requires timely source control.
Common Pitfalls
- Assuming a firm uterus rules out haemorrhage.
- Using fundal pressure for shoulder dystocia.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.