Postpartum Hemorrhage: NCLEX Priorities
PPH: 4 Ts (Tone, Trauma, Tissue, Thrombin), fundal massage, oxytocin, methergine.
PPH is the leading cause of maternal mortality globally. NCLEX tests the 4 Ts and management.
Definition
Blood loss >1000 mL after delivery (regardless of route).
4 Ts
Tone (uterine atony, most common, 70%), Trauma (laceration), Tissue (retained placenta), Thrombin (coagulopathy).
Management
Fundal massage first. Oxytocin infusion. Methylergonovine (Methergine) IM, avoid in HTN. Carboprost (Hemabate), avoid in asthma. Misoprostol sublingual/rectal. Tranexamic acid within 3h. Balloon tamponade, surgery, hysterectomy in refractory.
Resuscitation
Two large-bore IVs, type & cross, transfuse PRBCs, FFP, platelets in 1:1:1 ratio for massive transfusion.
Frequently asked
Boggy uterus, what to do?
Fundal massage. Increase oxytocin. Empty bladder. Add second uterotonic if no response.
Methergine and HTN?
Avoid, can cause severe hypertension.
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