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Postpartum haemorrhage — DIPIMC MCQ

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HardPaediatric and Obstetric EmergenciesPostpartum haemorrhageDIPIMCDipIMC

Shortly after an out-of-hospital delivery, the mother has heavy, continuing vaginal bleeding. The uterus feels soft and poorly contracted on abdominal palpation, and the placenta has been delivered and appears complete. What is the most appropriate immediate management?

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Correct answer: D — Give a uterotonic and rub up a contraction, transferring urgently

The soft, poorly contracted uterus indicates uterine atony, the commonest cause of primary postpartum haemorrhage, and management is to rub up a contraction with fundal massage, give a uterotonic such as oxytocin, gain intravenous access with fluids, and transfer urgently. Awaiting spontaneous contraction wastes time during major bleeding, and a pelvic binder does not treat uterine atony. Tranexamic acid is a useful adjunct but does not replace uterotonics and massage. Pearl: bimanual uterine compression can be life-saving while awaiting definitive care.

Reference: MBRRACE-UK; JRCALC Clinical Guidelines