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. A very important point to be noted is that "Physiological secretion of oxytocin from the posterior lobe of the pituitary gland" may be enhanced by putting the baby to the breast of the patient. It is the duty of midwife to ensure that the uterus is emptied or the placenta has to be delivered. Then the clots if any may be expelled by applying firm and gentle pressure on the fundus.
In emergency cases the patient's legs should be lifted to allow the blood to drain from them into central circulation, but the foot of the bed should not be raised to avoid the pooling of blood into uterus, thus preventing its contraction.
If the bleeding stops with the above measures, 10 ml blood may be collected for haemoglobin estimation and for cross-matching compatible blood. Then 40units of Syntocinon in one litre of dextrose/saline may be infused over a period of 8-12 hours to ensure continued uterine contraction and minimise the risk of recurrence.
If the placenta remains undelivered manual removal of placenta may be performed with full