Statistically, haemorrhage of more than 500ml is defined as Postpartum Haemorrhage." Post partum haemorrhage can be clinically classified into following three types:
According to Jones the placental remains in the uterus and poor retraction of muscle may lead to inefficient constriction of vessels resulting into bleeding. An important point to remember is that an "empty contracted uninjured uterus does not bleed."(1990)
First step would be calling a doctor immediately or summon the emergency obstetric unit on observation of postpartum haemorrhage. Under no circumstances should a collapsed patient be moved without resuscitation.
A skilled midwife is expected to feel the fundus with finger tips which if found to be soft and relaxed is massaged with a smooth, circular motion applying no undue pressure resulting into contraction. Once the contraction occurs the hand is held still. To sustain the contraction an oxytocic agent such as Syntometrine 1 ml is administered. Intravenously 0.25 to 0.5 mg Ergometrine is also injected as an alternative which is effective in 45 seconds time. Utmost care should be exercised in limiting the dosage of Ergometrine to two, including any dosage of Syntometrine to avoid pulmonary hypertension. ...