Many people attempt controlling postpartum haemorrhage due to uterine atony. Is there any evidence-based decision on the use of Intra-uterine gauze packing to control postpartum haemorrhage? What is the mechanism of action?
Instead of packing with gauze, use manual pressure on the uterus from outside, after the placenta is delivered. If you want to prevent all PPH, use this protocol, which was first published in Birth in 2010, and will appear again in the next issue of BIrth:
Judy’s 3-4-5 PROTOCOL: At the 36-week prenatal visit, the midwife squats in front of the client to teach and demonstrate to her exactly how she will deliver her placenta 5 minutes after the birth. The client’s consent is obtained.
Immediate continuous skin-to-skin contact with the baby is initiated for the first 3 1 ⁄ 2 minutes postpartum. The cord is cut at exactly 3 minutes postpartum while the baby is in her mother’s arms. The midwife keeps hands off the fundus and the cord. At 4 minutes: The midwife assists or directs the mother, as necessary, into a squatting position on the floor with both feet flat on the floor or on the floor of an empty bathtub. The mother hands the baby to someone or baby waits on the bed for one minute. The midwife encourages the woman to push out the placenta without a contraction. It is helpful to say things like: pushing out the placenta prevents bleeding and that the placenta is right there, ready to deliver. The woman is in a squatting position while she pushes out and births the placenta. The time of delivery is noted. Immediately after delivery of the placenta, the mother is dressed with a sanitary pad, assisted into the bed and immediately given the baby. The uterus is massaged once immediately to check for clots.
If bleeding is above average during the next 5 minutes, a shot of either 10 u Pitocin, 0.2 mg methergine intramuscularly, 0.125 mg methergine PO or whatever you have access to around 6 to 10 minutes postpartum. Early suckling at the breast is initiated, which generally takes place between 10 and 45 minutes postpartum depending on the baby.
No evidence of value of intrauterine packing, instead you can use Bakri balloon catheter
- Badges
- Science method