Author: Hannah Rickard

PPH Management Proforma

Time of PPH call/ buzzer…………………...………………... Call put out by………...……...…..………………………….. Date………………….
MO

Patient Details
Name
DOB
Hospital Number

Team Member	Name	Time arrived
Midwife
Senior midwife
On-call obstetric consultant
On-call obstetric registrar
On-call obstetric SHO
On-call anaesthetic consultant
On-call anaesthetic registrar
On-call ODP
Haematology lab aware
Cell salvage technician

	Time	Observations
FBC sent		Rec on MEOWS - 15 min
G+S sent		Fluids
Coagulation screen sent		Prescribe on drug chart
Blood cross matched		Blood products
Placenta Delivered		Prescribe on transf chart
Foley catheter + urometer		Consider
Suturing commenced		10ml 10% CaCl / 4u RBC

Measured Blood Loss (MBL)	Time	Volume	Running total
*MOH —Postnatal
care on LW minimum 6 hours
See High risk PN guideline
		TOTAL MBL

Drug—PRESCRIBE on chart	Dose	Time
Syntometrine	1 ampule (500mcg /5 units)-( if BP normal)
Syntometrine	1 ampule (500mcg / 5 units )-( if BP normal)
OR Oxytocin	5 units IV / IM (Dose 1)
Oxytocin	5 units IV / IM (Dose 2)
Oxytocin infusion	40 units in 500ml normal saline, 125ml/h
OR Carbetocin	100mcg slow IV by anaesthetist only
Tranexamic Acid	1 g IV (Dose 1 bolus)
Tranexamic Acid	1 g IV infusion (Dose 2)
Ergometrine	500 mcg IM IV (if BP normal)
Carboprost	250 mcg IM (Dose 1)
Carboprost	250 mcg IM (Dose 2)
Carboprost	250 mcg IM (Dose 3)
Carboprost	250 mcg IM (Dose 4)
Carboprost	250 mcg IM (Dose 5)
Misoprostol	1000mcg PR

Initial Management	Time
Oxygen 15 L/min
IV cannula 1
IV cannula 2
Urinary urethral catheter inserted
Further Management	Time
MOH (massive obstetric haemorrhage) call—2222 (EBL >1500ml) *
Transfer to theatre
Balloon tamponade
Other procedures/PN FBC and coag/epidural removal timing

Patient name
Hosp no DOB

PPH Risk Assessment Tool

DATE AND TIME OF ASSESSMENT
ANTENATAL RISK FACTORS	Score	AN	1st	2nd	PN
Current Placenta Praevia/ Accreta	10
Current Placental Abruption	10
Current Multiple pregnancy and/or polyhydramnios	6
Current Hb < 85g/l and/or platelets below 100	6
Previous Massive PPH (>2L and/or blood transfusion)	6
Intrauterine Death (in this pregnancy)	6
APH current ( or history of recurrent in this pregnancy)	3
Previous PPH (>750ml—2L and no blood transfusion)	4
High BP (Essential/ Gestational / PET / HELLP)	4
Clotting / platelet disorder / Currently on Aspirin or SSRI	3
Previous Parity ≥4 / previous parity ≥3	3/2
Previous MROP	3
Current BMI >45 / BMI >35	4/2
Current large / multiple uterine Fibroids	2
Black or Asian Ethnicity	2
Estimated fetal weight >4.5kg	2
Previous Caesarean, Elective Caesarean section today	2
INTRAPARTUM CURRENT RISK FACTORS
Prolonged 1st stage of labour (>12 hours)/ > 12 hours of oxytocin	3	-
Sepsis/ Pyrexia in labour	2	-
Induction or augmentation of labour (Prostaglandin or oxytocin)	2	-
Emergency Caesarean section	2	-
Prolonged 2nd stage of labour >2 hours	2	-
POSTPARTUM RISK FACTORS
Retained placenta/ MROP	6	-	-	-
Operative Vaginal Delivery	3	-	-
Shoulder dystocia	2	-	-
Extensive trauma or 3rd/4th degree tear	2	-	-	-
PPH Risk Score	-
Name and designation

NOTES
Tick boxes right when actions completed
Check placental site
Current G+S <72hrs
Red blood cell antibodies ?
If booking weight <50kg activate MOH at 1L
Amber/Red start PPH Proforma at delivery

MODERATE RISK—PPH score 2-5 / □ FBC and G+S □IV access □Active 3rd stage
HIGH RISK—PPH score 6-9 (as for green PLUS) / □ LSCS: Carbetocin 100mcg □ Consider cell salvage / □ Prescribe PN 40 units oxytocin IV (GIVE after delivery) / □ Prescribe Tranexamic Acid 1g (GIVE when EBL=500ml)
VERY HIGH RISK—PPH score >10 (as for amber PLUS) / □ Min 4 hours LW post natal □ consider XM 2 U blood / □ 2nd IV access □MDT Plan documented

Patient Details
Name
DOB
Hospital Number