Postpartum Hemorrhage

By VeriScorePrep Team · 4 min

Postpartum hemorrhage is excessive bleeding after birth — typically estimated >500 mL (vaginal) or >1000 mL (cesarean), or any bleeding that causes hemodynamic instability. Memorize the four T's.

Tone (most common)

Uterine atony — a soft, boggy fundus that cannot contract. Fundal massage is the first intervention; if it does not firm up, escalate: oxytocin, methylergonovine (avoid in hypertension), carboprost (avoid in asthma), misoprostol. Empty the bladder — a full bladder displaces the uterus.

Trauma

Lacerations or hematoma from delivery. Inspect the perineum, vagina, and cervix; repair and document.

Tissue

Retained placental fragments prevent contraction. Inspect the placenta for completeness; retained tissue may require manual removal or uterotonic agents.

Thrombin

Coagulopathy — from HELLP, amniotic fluid embolus, or preexisting bleeding disorder. Use blood products and clotting factors as directed.

Monitoring

In the fourth stage, check fundus and lochia every 15 minutes. Pad counts and estimated blood loss catch occult bleeding. Vital signs reflect hemodynamic status — tachycardia and hypotension are late signs.