Post-Partum Hemorrhage

In this podcast episode, Dr. Anand Swaminathan discusses postpartum hemorrhage, sharing insights from his experience and emphasizing the importance of recognizing and managing this critical condition. He highlights that while postpartum hemorrhage may not be a common occurrence in the emergency department, it requires swift and informed action when it does occur. Dr. Swaminathan covers key points such as early recognition, resuscitation strategies, and the four T's (Tone, Tissue, Trauma, and Thrombin) as a framework for identifying the source of bleeding. He also touches on the use of tranexamic acid, involving OB and surgical teams, and the potential need for hysterectomy in severe cases. The episode provides valuable takeaways for healthcare professionals dealing with postpartum hemorrhage scenarios.

Key Takeaway Points:

1. Early Recognition: Promptly recognize postpartum hemorrhage by considering both the defined criteria (500 cc's or more of bleeding) and any bleeding that exceeds the expected post-delivery amount.
2. Resuscitation Strategies: Focus on resuscitation with two large bore IVs, prioritizing blood over crystalloids, and considering tranexamic acid. Aim for a balanced one to one to one ratio of blood products.
3. Four T's Framework: Utilize the four T's (Tone, Tissue, Trauma, and Thrombin) as a systematic approach to identifying the underlying cause of bleeding, helping guide appropriate interventions.
4. Consultation and Collaboration: Involve obstetric and surgical teams early in the process, especially in scenarios where postpartum hemorrhage management may require specialized interventions like a hysterectomy.
5. Timely Transfer: When necessary, ensure timely transfer to a facility that can provide further specialized care, especially in cases involving DIC or persistent bleeding despite initial interventions.