Postpartum haemorrhage in recovery

haemorrhage obstetric recovery Aug 25, 2025

Recovery room red flags: Postpartum Haemorrhage 💉

Postpartum haemorrhage (PPH) is defined by the Royal College of Obstetricians and Gynaecologists as blood loss ≥ 500mls within the first 24hrs after birth. PPH may be the reason a patient presents to theatre, or it may be something that occurs in the immediate postoperative phase following a caesarean section or assisted vaginal birth. PPH can be abrupt and rapid, or it can be a slow, insidious trickle. In any event, prompt recognition in the recovery room is essential to prevent maternal morbidity.

Here’s what you need to know about PPH:

🔹 Risk factors

  • Placenta previa
  • Placental abruption
  • Multiple gestation
  • Pre-eclampsia
  • History of PPH
  • BMI > 35
  • Anaemia
  • Fibroids
  • Clotting disorders (or any blood thinning medication)
  • Caesarean section
  • Induced labour
  • Retained placenta
  • Perineal trauma
  • Prolonged labour
  • Maternal age > 40
  • General anaesthesia

🔹 Assessment

  • Observable blood loss and signs of ongoing bleeding
  • Quantitative blood loss – weighing pads, packs, blueys etc rather than estimating
  • Haemodynamic monitoring ❤️
  • Uterine tone and fundal palpation – a “boggy” feeling uterus suggests atony, the most frequent cause of PPH
  • Bladder function – bladder distention can impair uterine contraction

🔹 Management

If PPH is suspected, urgent attention is required and you should send for help and alert the obstetric team as a priority. Immediate management includes:

  • Uterine massage to stimulate contractions
  • Administration of uterotonics such as misoprostol and/or ergometrine 💊
  • Ensure adequate IV access is maintained
  • Maintain bladder drainage and monitor fluid balance and haemodynamics
  • If bleeding continues despite these measures, additional uterotonics may be used, a blood transfusion may be required, and in critical circumstances, a return to theatre for balloon tamponade, uterine artery embolisation, laparotomy and/or hysterectomy.

One of the most important considerations in the event of PPH is clear communication with the mother, and also with their partner/support person. Emotions are already high with the birth of a child, so emotional support and compassion are essential in providing holistic care for your patient.

Build Knowledge ✅

Improve Safety ✅

References:

Mavrides E, Allard S, Chandraharan E, Collins P, Green L, Hunt BJ, Riris S, Thomson AJ on behalf of the Royal College of Obstetricians and Gynaecologists. Prevention and management of postpartum haemorrhage. BJOG 2016;124:e106–e149

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