Do not perform vaginal exam or attempt vaginal packing.

Antepartum (Before Delivery)

• Apply perineal pad; note time to assess amount of bleeding.
• Position mother on left side! Relieves compression of IVC and enhances venous return and uteroplacental perfusion.
• Prepare for emergency c-section if necessary.

Postpartum Hemorrhage

• Massage mother's fundus (abdomen) or encourage breastfeeding if appropriate to stimulate uterine contractions.
• Control external bleeding with direct (external) pressure.
• Place mother in Trendelenburg position.
• Establish 2nd large-bore IV and titrate to SBP >90 mm Hg.
• Oxytocin may be prescribed: (postpartum hemorrhage only!) 10 units mixed in 1000 mL LR titrated to effect (give 3-10 units IM if no IV access).