What are the current guidelines for the management of postpartum hemorrhage in primary care settings?

Management of postpartum hemorrhage (PPH) in primary care settings involves immediate recognition and urgent action to stabilise the woman and arrange transfer to obstetric-led care.

If a woman presents with PPH, the first step is to call for help immediately and initiate clinical treatment including emptying the bladder, uterine massage, administration of uterotonic drugs, intravenous fluids, and controlled cord traction if the placenta is undelivered.

Continuous assessment of blood loss and the woman's condition is essential, alongside identifying the bleeding source.

Supplementary oxygen should be considered, starting at 15 L/min via a non-rebreathing mask to maintain oxygen saturation between 94% and 98%.

Secure intravenous access if the placenta is retained and give intravenous oxytocic agents if there is excessive bleeding.

Do not perform uterine exploration or manual removal of the placenta without anaesthesia.

Women with antenatal risk factors for PPH should be advised to give birth in an obstetric unit where emergency treatment options are available.

In primary care, after initial stabilisation, arrange urgent transfer to an obstetric unit following local transfer protocols, considering cumulative risk factors that may increase urgency.

For women presenting postnatally with heavy or persistent vaginal bleeding suggestive of secondary PPH, urgent hospital admission should be arranged.

Ultrasound may be helpful to assess for retained placental tissue or endometritis if emergency admission is not immediately required.

Advise women antenatally and postnatally about the signs of abnormal bleeding and when to seek medical advice.