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rorrhagia
or, if not av ailable,
salbutamol IV infusion for 48 h ours m axim um : d ilute 5 m g (10 am poules of 0.5 m g ) in
500 m l of 5% g lucose or 0.9% sod ium ch lorid e to ob tain a solution of
10 m icrog ram s/m l.
S tart infusion at th e rate of 15 to 20 m icrog ram s/m inute (30 to 40 d rops/m inute).
If contractions persist, increase th e rate by 10 to 20 d rops/m inute ev ery 30 m inutes
until uterine contractions cease. Do not exceed 45 m icrog ram s/m inute
(90 d rops/m inute).
Continue for one h our after contractions h av e ceased , th en red uce th e rate by h alf
ev ery 6 h ours.
M onitor m aternal pulse reg ularly, d ecrease th e infusion rate in th e ev ent of m aternal
tach ycard ia (> 120/m inute).
Do not com bine nifed ipine and salbutam ol.
E ith er tocolysis is effectiv e and contractions cease or d im inish : in both cases, d o not
prolong treatm ent ov er 48 h ours. Bed rest until th e end of preg nancy.
O r tocolysis is not effectiv e, contractions persist and labour beg ins: take necessary steps
for a prem ature birth .
Post-partum haemorrhage
Clinical features
Haem orrh ag e, exceed ing th e usual 500 m l of a norm al placental d eliv ery th at occurs in
th e first 24 h ours (usually im m ed iately) follow ing th e d eliv ery of th e ch ild . P ost-
partum h aem orrh ag e is m ainly d ue to placental retention and uterine atonia, but m ay
also result from uterine rupture or cerv ical or v ag inal lacerations.
Management
– If systolic BP is < 90 m m Hg , elev ate th e leg s (keep or replace th e patient's feet in th e
d eliv ery table stirrups).
– U nd er g eneral anaesth esia and antibiotic proph ylaxis ( ampicillin or cefazolin IV, 2 g as
a sing le d ose): m anual rem ov al of th e placenta (if not yet d eliv ered ) and system atic
m anual exploration of th e uterus to rem ov e any clots/placental d ebris and to m ake
sure th e uterus h as not ruptured .
– T h en oxytocin: 10 IU d iluted in 500 m l of Ring er lactate, at a rate of 80 d rops/m inute.
At th e sam e tim e, ad m inister 5 to 10 IU by IV push , to be repeated if necessary until
retraction of uterus, with out exceed ing a total d ose of 60 IU .
– M assag e of th e uterus to expel any clots and aid uterine retraction.
– Continue m onitoring (pulse, BP , blood loss). Bleed ing sh ould d im inish and th e uterus
sh ould rem ain firm .
– M easure h aem og lobin.
– Insert a urinary cath eter to facilitate uterine retraction.
For m ore inform ation on th e m anag em ent of preg nancy-related bleed ing , refer to th e
M S F h and book, Obstetrics.
250
or, if not av ailable,
salbutamol IV infusion for 48 h ours m axim um : d ilute 5 m g (10 am poules of 0.5 m g ) in
500 m l of 5% g lucose or 0.9% sod ium ch lorid e to ob tain a solution of
10 m icrog ram s/m l.
S tart infusion at th e rate of 15 to 20 m icrog ram s/m inute (30 to 40 d rops/m inute).
If contractions persist, increase th e rate by 10 to 20 d rops/m inute ev ery 30 m inutes
until uterine contractions cease. Do not exceed 45 m icrog ram s/m inute
(90 d rops/m inute).
Continue for one h our after contractions h av e ceased , th en red uce th e rate by h alf
ev ery 6 h ours.
M onitor m aternal pulse reg ularly, d ecrease th e infusion rate in th e ev ent of m aternal
tach ycard ia (> 120/m inute).
Do not com bine nifed ipine and salbutam ol.
E ith er tocolysis is effectiv e and contractions cease or d im inish : in both cases, d o not
prolong treatm ent ov er 48 h ours. Bed rest until th e end of preg nancy.
O r tocolysis is not effectiv e, contractions persist and labour beg ins: take necessary steps
for a prem ature birth .
Post-partum haemorrhage
Clinical features
Haem orrh ag e, exceed ing th e usual 500 m l of a norm al placental d eliv ery th at occurs in
th e first 24 h ours (usually im m ed iately) follow ing th e d eliv ery of th e ch ild . P ost-
partum h aem orrh ag e is m ainly d ue to placental retention and uterine atonia, but m ay
also result from uterine rupture or cerv ical or v ag inal lacerations.
Management
– If systolic BP is < 90 m m Hg , elev ate th e leg s (keep or replace th e patient's feet in th e
d eliv ery table stirrups).
– U nd er g eneral anaesth esia and antibiotic proph ylaxis ( ampicillin or cefazolin IV, 2 g as
a sing le d ose): m anual rem ov al of th e placenta (if not yet d eliv ered ) and system atic
m anual exploration of th e uterus to rem ov e any clots/placental d ebris and to m ake
sure th e uterus h as not ruptured .
– T h en oxytocin: 10 IU d iluted in 500 m l of Ring er lactate, at a rate of 80 d rops/m inute.
At th e sam e tim e, ad m inister 5 to 10 IU by IV push , to be repeated if necessary until
retraction of uterus, with out exceed ing a total d ose of 60 IU .
– M assag e of th e uterus to expel any clots and aid uterine retraction.
– Continue m onitoring (pulse, BP , blood loss). Bleed ing sh ould d im inish and th e uterus
sh ould rem ain firm .
– M easure h aem og lobin.
– Insert a urinary cath eter to facilitate uterine retraction.
For m ore inform ation on th e m anag em ent of preg nancy-related bleed ing , refer to th e
M S F h and book, Obstetrics.
250
