Managing Complications in Pregnancy and Childbirth: - IAWG

S-32 Vaginal bleeding after childbirth• If bleeding continues in spite of compression:- Perform uterine and utero-ovarian artery ligation (page P-99);- If life-threatening bleeding continues after ligation, performsubtotal hysterectomy (page P-103).TEARS OF CERVIX, VAGINA OR PERINEUMTears of the birth canal are the second most frequent cause of PPH.Tears may coexist with atonic uterus. Postpartum bleeding with acontracted uterus is usually due to a cervical or vaginal tear.• Examine the woman carefully and repair tears to the cervix (page P-81) or vagina and perineum (page P-83).• If bleeding continues, assess clotting status using a bedsideclotting test (page S-2). Failure of a clot to form after 7 minutes or asoft clot that breaks down easily suggests coagulopathy (page S-19).RETAINED PLACENTAThere may be no bleeding with retained placenta.• If you can see the placenta, ask the woman to push it out. If youcan feel the placenta in the vagina, remove it.• Ensure that the bladder is empty. Catheterize the bladder, ifnecessary.• If the placenta is not expelled, give oxytocin 10 units IM if notalready done for active management of the third stage.Do not give ergometrine because it causes tonic uterinecontraction, which may delay expulsion.• If the placenta is undelivered after 30 minutes of oxytocinstimulation and the uterus is contracted, attempt controlled cordtraction (page C-74).