- Substandard care has been identified in the majority of maternal deaths from massive post partum haemorrhage.
- A common problem is the under-estimation of blood loss which leads to failure of early intervention.
- Massive blood loss can occur within minutes!
- The goal of management is ‘organized time conscious team approach’.
- All mothers should have an antenatal risk assessment for PPH to determine the appropriate place of delivery.
- Management should be individualized depending on the severity of blood loss, rate of loss, haemodynamic instability, body weight, baseline haemoglobin and the availability of resources.
- Active interventions in the “golden hour” is critical
- Always consider the possibility of a concealed haemorrhage.
- In the presence of blood clots, a rough estimate should be double of the estimated blood lost in the illustration above (estimated blood x 2)