Dr Kola Tytler MBBS CertHE MBA MSt MRCGPClinical Lead • iatroX
To determine whether a patient with postpartum haemorrhage (PPH) requires referral to secondary care, the following criteria should be considered:
- Immediate Transfer to Obstetric-Led Care or Emergency Hospital Admission:
- If a woman has a postpartum haemorrhage, transfer to obstetric-led care should be arranged NICE NG235.
- Emergency hospital admission is indicated for suspected secondary postpartum haemorrhage NICE CKS.
- If the placenta is retained and the woman is not already in an obstetric unit, transfer should be arranged, with urgency increasing if multiple risk factors are present NICE NG235.
- Referral directly to Accident and Emergency is necessary if the woman is haemodynamically unstable, including signs such as pallor, tachycardia, hypotension, shock, or collapse NICE CKS,NICE CKS.
- Significant concern about the degree of bleeding or pain also warrants direct referral to Accident and Emergency NICE CKS,NICE CKS.
- Factors Worsening Consequences (Lowering Referral Threshold):
- Be aware that anaemia may worsen the consequences of secondary postpartum haemorrhage NICE NG194.
- A weight of less than 50 kg at the first midwife appointment during pregnancy (booking appointment) may also worsen the consequences of secondary postpartum haemorrhage NICE NG194.
- Antenatal Considerations:
- Women with antenatal risk factors for PPH should be advised to give birth in an obstetric unit, where more emergency treatment options are available NICE NG235.