[Initial obstetrical management of post-partum hemorrhage following vaginal delivery]

Abstract

Objectives: To define initial steps of obstetrical treatment of post-partum hemorrhage (PPH) after vaginal delivery.

Materials and method: We searched the Medline and the Cochrane Library and checked the international guidelines: HAS, RCOG, SOGC, ACOG and WHO.

Results: In case of PPH, the use of a collecting bag is recommended (professional consensus). All the concerned professional (midwife, obstetrician, anesthesiology team) must be warned immediately (professional consensus). If placenta is retained, manual removal needs to be performed and after placental delivery, manual uterine exploration is recommended (professional consensus). At the same time, a dose of 5 or 10 IU of oxytocin must be administrated IV over at least 1minute or directly by an intramuscular injection followed by an infusion of 5 to 10 UI/h during 2hours (professional consensus). In some situations at risk of cervical and high vaginal laceration, the low genital tract needs to be carefully examined (professional consensus). Appropriate management of PPH has to be known by the concerned professional (professional consensus). Retrospective study of each case of PPH should be done (professional consensus).

Conclusion: The PPH initial treatment involves a team work that, most of times, leads to stop the bleeding in least than 30minutes (professional consensus).

Keywords: Délivrance artificielle; Hémorragie du post-partum; Manual placenta removal; Manual uterine examination; Oxytocin; Oxytocine; Post-partum hemorrhage; Révision utérine.