Management of Atonic Obstetric Haemorrhage-"HAEMOSTASIS"
General medical management
H-call for help
A-assess (vital signs/blood loss) & resuscitate
E-Establish aeitiology(4T-Tone/Tissue/ Trauma/Thrombin)
E-Ecbolics(syntometrine/ergometrine/bolus syntocinon)
E-Ensure availability of blood products
M-Massage the uterus
O-Oxytocin infusion,prostaglandins(intravenous,rectal,intramuscular,intramyometrial)
Specific surgical management
S-shift to operating theatre(bimanual compression anti-shock garment,especially if tranfer is required
T-Tissue & trauma to be exculded & balloon tamponade or uterine packing
A-apply compression sutures
S-sytematic pelvic devascularisation(uterine,ovarian,quadruple,internal iliac)
I-interventional radiology,uterine artery embolisation
S-Subtotal/Total hysterectomy
Source:
Mukherjee S, Arulkumaran S. Post-partum haemorrhage. Obstetrics, Gynaecology & Reproductive Medicine. 2009 5;19(5):121-126.
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