The table below summarises some key points to remember during emergency referral for postpartum haemorrhage, or any of the other life-threatening emergencies described in earlier study sessions.

Important activities during transfer of the woman to a hospital.

Aim to maintain:	Actions
Contraction of the uterus	Apply gentle uterine massage, or two-handed compression of the uterus, and maintain this during referral
Empty bladder	If the woman cannot urinate, insert a self-retaining catheter to drain the bladder and leave it in place during referral
Adequate blood volume	If the woman is haemorrhaging or in shock, administer intravenous fluids and maintain the infusion during referral
Vital signs	Check colour, pulse, blood pressure, temperature, blood loss, level of consciousness
Warmth	Cover the woman with blankets
Position	The woman should lie flat, but with her legs raised above the height of her head to help maintain her blood pressure
Confidence	Give the woman your emotional support and reassurance; keep her as calm as possible
Accurate records and referral note	Write down all your findings and the interventions you are making on the referral note, with the woman's history and identification details

Aim to maintain:

Actions

Contraction of the uterus

Apply gentle uterine massage, or two-handed compression of the uterus, and maintain this during referral

Empty bladder

If the woman cannot urinate, insert a self-retaining catheter to drain the bladder and leave it in place during referral

Adequate blood volume

If the woman is haemorrhaging or in shock, administer intravenous fluids and maintain the infusion during referral

Vital signs

Check colour, pulse, blood pressure, temperature, blood loss, level of consciousness

Warmth

Cover the woman with blankets

Position

The woman should lie flat, but with her legs raised above the height of her head to help maintain her blood pressure

Confidence

Give the woman your emotional support and reassurance; keep her as calm as possible

Accurate records and referral note

Write down all your findings and the interventions you are making on the referral note, with the woman's history and identification details

What are the two most important points to remember about PPH?

Show answer

You should remember that:

Although some risk factors are associated with PPH, two thirds of women who develop PPH have no known risk factors. Which women will develop PPH is therefore highly unpredictable.
Because of this you need to be alert to the possibility of PPH for every woman in your care who gives birth. And because PPH is life-threatening you must be ready to take appropriate emergency action, including getting her as quickly as possible to a health facility.