Nursing Component Task
Nursing procedures & clinical learning

Midwifery (RM)

Management of Postpartum Haemorrhage

Postpartum haemorrhage is excessive or progressive bleeding after birth that can rapidly cause deterioration. Management is an emergency requiring coordinated resuscitation, uterine assessment, uterotonics and other prescribed measures, identification of the cause, and escalation.

Purpose

  • Resuscitate the woman and prevent hypovolaemic shock
  • Reduce bleeding and identify the cause
  • Prevent maternal morbidity and mortality

Indications

  • Excessive or ongoing bleeding after vaginal or operative birth
  • A boggy or enlarged uterus, retained tissue, genital-tract trauma, or coagulopathy
  • Any maternal deterioration with suspected postpartum bleeding

Equipment

  • Emergency call and haemorrhage trolley
  • Two large-bore IV cannulas, fluids, blood-sampling and transfusion supplies
  • Vital-sign and oxygen equipment
  • Uterotonics and medicines as prescribed
  • Urinary catheter and measuring system
  • Pads, PPE, examination and repair equipment
  • Documentation and referral forms

Preparation

  • Know the local haemorrhage protocol and keep emergency equipment checked.
  • Ensure blood products, theatre, anaesthesia, and referral pathways can be activated.

Procedure steps

  • Call for help, note the time, quantify blood loss, assess airway, breathing, circulation, consciousness, and vital signs.
  • Massage a boggy uterus when indicated, assess uterine tone, inspect for retained placenta or tissue and genital-tract trauma with the authorized team.
  • Establish large-bore IV access, take blood for group and cross-match and investigations, and begin prescribed fluid or blood resuscitation.
  • Administer prescribed uterotonics and other treatment without delaying escalation.
  • Empty the bladder or insert a catheter as ordered, monitor urine output, and maintain warmth and oxygen if indicated.
  • Assess the four major causes: tone, tissue, trauma, and thrombin or coagulopathy.
  • Prepare for examination, manual removal, repair, theatre, transfer, or advanced resuscitation according to response.
  • Monitor vital signs, bleeding, uterine tone, consciousness, urine output, and treatment response continuously.
  • Explain the emergency actions to the woman and support person and maintain dignity.
  • Document every assessment, intervention, medication, volume, response, communication, and handover.

Precautions

  • Treat postpartum haemorrhage as an emergency even when the woman initially appears stable.
  • Do not leave the woman alone or delay senior review.
  • Use uterotonics only as prescribed and monitor contraindications.
  • Prevent hypothermia, medication errors, and inaccurate blood-loss estimation.

Aftercare

  • Continue observation for recurrent bleeding, anaemia, shock, renal injury, and emotional trauma.
  • Provide debriefing, breastfeeding support, follow-up, and referral after stabilization.

Nursing considerations

  • Use a team leader and closed-loop communication.
  • Reassess after every intervention and communicate deterioration immediately.

Patient education

  • Explain what happened, warning signs, medicines, follow-up, and emotional support options after stabilization.
  • Encourage the woman to report renewed bleeding, dizziness, breathlessness, or weakness.

Documentation

  • Record estimated blood loss, observations, uterine findings, causes, interventions, medications, fluids, blood, response, staff, and times.
  • Complete incident, transfusion, referral, and handover records.

References and further reading

Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.

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