Managing Complications in Pregnancy and Childbirth: - IAWG

Vaginal bleeding in later pregnancy and labourS-19• Assess clotting status using a bedside clotting test (page S-2).Failure of a clot to form after 7 minutes or a soft clot that breaksdown easily suggests coagulopathy (page S-19).• Transfuse as necessary, preferably with fresh blood (page C-23).• If bleeding is heavy (evident or hidden), deliver as soon aspossible:- If the cervix is fully dilated, deliver by vacuum extraction(page P-27);- If vaginal delivery is not imminent, deliver by caesareansection (page P-43).Note: In every case of abruptio placentae, be prepared forpostpartum haemorrhage (page S-25).• If bleeding is light to moderate (the mother is not in immediatedanger), the course of action depends on the fetal heart sounds:- If fetal heart rate is normal or absent, rupture the membraneswith an amniotic hook or a Kocher clamp (page P-17):- If contractions are poor, augment labour with oxytocin(page P-25);- If the cervix is unfavourable (firm, thick, closed), performcaesarean section (page P-43).- If fetal heart rate is abnormal (less than 100 or more than 180beats per minute):- Perform rapid vaginal delivery;- If vaginal delivery is not possible, deliver by immediatecaesarean section (page P-43).COAGULOPATHY (CLOTTING FAILURE)Coagulopathy is both a cause and a result of massive obstetrichaemorrhage. It can be triggered by abruptio placentae, fetal death inutero,eclampsia, amniotic fluid embolism and many other causes. Theclinical picture ranges from major haemorrhage, with or withoutthrombotic complications, to a clinically stable state that can bedetected only by laboratory testing.