Full Post-Partum Hemorrhage Protocol

PPH Risk Assessment

L&D patients are assessed for PPH risk at time of admission (by OB provider with nursing involvement).

• Identify patients who may decline transfusion AND:
  • Refer to the ZSFG Declination of Blood Products for Obstetric Patients Management Guideline
  • Notify OB Chief and Attending, and Anesthesia service.
  • Ask patient to sign the blood declination form entitled “3-318 Declination of Blood Products for Obstetrics.” This may have been signed prenatally in Anesthesia Pre-Op Clinic and uploaded under the EPIC Media tab.
  • Communicate the patient’s choices to the whole team during Safety Rounds.
• Identify patients who do not have Type & Screen from their prenatal record. They will need a Type & Screen on admission. For patients who do not have any previous Blood Bank results in the EPIC system, they will need an additional ABO/Recheck, drawn at a separate time from the Type & Screen.
• If Ab screen positive (if not low-level anti-D from RhoGAM), order Type & Crossmatch 2-4 unit of PRBCs depending on risk factors.
• Identify hemorrhage risk factors and choose appropriate Blood Bank order (see tables below)
  • Type & Hold = ABO/Rh (order in EPIC)
  • Type & Screen = Antibody screen (order in EPIC)
  • Type & Cross = Prepare/transfuse blood (order in EPIC)

Admission Risk Assessment and Appropriate Blood Bank Orders

Ongoing Risk Assessment

Treatment Checklist

PDF Checklist

Please see complete guideline for details.

PPH Drugs

Etiologies of PPH

• Uterine atony
• Trauma/Laceration
• Retained placenta
• Amniotic Fluid Embolism
• Uterine inversion
• Coagulopathy
• Abnormal placentation such as placenta accreta, increta, or percreta; and placenta previa
• Vulvar, vaginal, intraabdominal, and retroperitoneal hematomas
• Disseminated Intravascular Coagulation

Full PPH Guideline

Last updated June 2023 by A. Wight, based on PPH Guideline 2022