For qualified healthcare professionals only — obstetric emergency use.
PPH is a life-threatening emergency. This tool provides dosing guidance only — it does not replace resuscitation, senior clinician involvement, or surgical intervention. Call for help immediately. Activate massive haemorrhage protocol if available.
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Clinically reviewed by
Dr. Hauwa Musa, FWACS
Consultant Obstetrician & Gynaecologist, National Hospital Abuja
Postpartum haemorrhage (PPH) is defined as blood loss ≥500 mL within 24 hours of birth (or ≥1000 mL for caesarean section) and is the single leading cause of maternal mortality globally, accounting for approximately 27% of all maternal deaths. In sub-Saharan Africa, PPH causes an estimated 34% of maternal deaths — higher than the global average. Nigeria alone accounts for approximately 20% of global maternal PPH deaths. Most PPH deaths are preventable with timely, protocol-driven management. This tool integrates WHO 2023 PPH recommendations, the WOMAN trial evidence base for tranexamic acid (TXA), and FMOH Nigeria uterotonic escalation pathways in a rapid-access emergency format.
Shock Index = Heart Rate ÷ Systolic Blood Pressure. A value >1.0 indicates haemorrhagic shock. >1.7 indicates severe shock with need for immediate blood transfusion. Blood pressure may be maintained until 30–40% of blood volume is lost — the shock index detects haemodynamic compromise earlier than systolic BP alone and is a validated triage tool in PPH.
Give TXA 1g IV over 10 minutes within 3 hours of birth for all PPH. The WOMAN trial (20,000 women, 21 countries) showed TXA reduced PPH mortality by 19% when given within 3 hours of delivery. A second 1g dose can be given if bleeding continues after 30 minutes or restarts within 24 hours. TXA is safe in breastfeeding. Do not give if there is a history of thrombosis or active thromboembolic disease.
Step 1: Oxytocin 10 IU IM or slow IV. Step 2: Ergometrine 0.2–0.5 mg IM (avoid in hypertension). Step 3: Misoprostol 800 mcg sublingual (if oxytocin unavailable or failed). Step 4: Carboprost 250 mcg IM every 15–90 minutes (max 8 doses) — avoid in asthma. Step 5: TXA throughout. Step 6: Balloon tamponade, B-Lynch suture, or hysterectomy if medical management fails.
The WHO-recommended escalation sequence for atonic PPH is: (1) Oxytocin 10 IU IM or IV slow bolus immediately after delivery; (2) if bleeding persists after 5 minutes — ergometrine 0.2 mg IM (avoid in hypertension) or oxytocin infusion 20 IU in 500 mL at 60 drops/minute; (3) misoprostol 800 micrograms sublingual; (4) carboprost 0.25 mg IM every 15 minutes up to 8 doses (avoid in asthma); (5) surgical intervention if pharmacological measures fail within 20–30 minutes. TXA 1 g IV should be given alongside uterotonics as soon as PPH is diagnosed.
Massive haemorrhage protocol (MHP) for obstetric haemorrhage aims for a packed red cell to fresh frozen plasma ratio of 1:1 to 1:2 to replace both red cell mass and clotting factors simultaneously. Cryoprecipitate or fibrinogen concentrate is given when fibrinogen falls below 2 g/L — common in obstetric DIC. Platelet transfusion targets a count above 50 × 10⁹/L. In settings with limited blood products, early administration of TXA, aggressive uterotonic therapy, and rapid surgical control are the priorities. Cell salvage is safe in obstetric haemorrhage and recommended by RCOG.
Related calculators
For broader obstetric emergency drug dosing including magnesium sulphate and antihypertensives, see the Obstetric Drug Dosing Calculator.
📋 Guideline basis: WHO PPH 2012 · RCOG GTG52 2016 · FMOH Nigeria · Last reviewed: January 2025 · Next review due: January 2026 · Disclaimer · Report an error
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