Action
- Suture lacerations
- Obtain obstetric consult for surgical management
Background
Lacerations sustained during delivery are very common. The vast majority of these are venous, but they can be significant sources of bleeding. Lacerations can occur anywhere along the birth canal including the cervix, vaginal canal, vulva, and perineum. Lacerations can also be internal, due to uterine artery injuries. In these cases, surgical exploration or arterial embolization may be necessary.
Genital tract hematomas can occur, especially after precipitous delivery or operative vaginal delivery. Pressure or pain in the labia, rectum, or pelvis, or deterioration of vital signs may occur and should prompt further evaluation. ACOG recommends conservative management of genital tract hematomas unless there is rapid enlargement, at which point surgical evacuation or arterial embolization may be considered.
Definitive Management
Continued severe blood loss requires consultation with obstetrics for surgical intervention. If medical management and conservative therapies fail, emergent hysterectomy is the definitive treatment for postpartum hemorrhage.
- United States Centers for Disease Control and Prevention. Preventing Pregnancy-Related Deaths. Accessed September 1, 2021. (Informational website)
- United States Centers for Disease Control and Prevention. Pregnancy Mortality Surveillance System. Accessed September 1, 2021. (Surveillance data)
- The Joint Commission. Provision of care, treatment, and services standards for maternal safety. R3 Report: Requirement, Rationale, Reference. 2019(24):1-6. (Rationale statement)
- Practice Bulletin No. 183: postpartum hemorrhage. Obstet Gynecol. 2017;130(4):e168-e186. (Practice guideline)
- World Health Organization. WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. Accessed September 1, 2021. (Practice guideline)
- Quantitative blood loss in obstetric hemorrhage: ACOG Committee Opinion Summary, Number 794. Obstet Gynecol. 2019;134(6):1368-1369. (Practice guideline)
- Creanga AA, Berg CJ, Ko JY, et al. Maternal mortality and morbidity in the United States: where are we now? J Womens Health (Larchmt). 2014;23(1):3-9. (Review)
- Anderson JM, Etches D. Prevention and management of postpartum hemorrhage. Am Fam Physician. 2007;75(6):875-882. (Practice recommendations)
- Kandeel M, Sanad Z, Ellakwa H, et al. Management of postpartum hemorrhage with intrauterine balloon tamponade using a condom catheter in an Egyptian setting. Int J Gynaecol Obstet. 2016;135(3):272-275. (Prospective observational study; 151 patients)
- Darwish AM, Abdallah MM, Shaaban OM, et al. Bakri balloon versus condom-loaded Foley’s catheter for treatment of atonic postpartum hemorrhage secondary to vaginal delivery: a randomized controlled trial. J Matern Fetal Neonatal Med. 2018;31(6):747-753. (Randomized controlled trial; 66 patients)
- Rathore AM, Gupta S, Manaktala U, et al. Uterine tamponade using condom catheter balloon in the management of non-traumatic postpartum hemorrhage. J Obstet Gynaecol Res. 2012;38(9):1162-1167. (Prospective study; 18 patients)
- Tindell K, Garfinkel R, Abu-Haydar E, et al. Uterine balloon tamponade for the treatment of postpartum haemorrhage in resource-poor settings: a systematic review. BJOG. 2013;120(1):5-14. (Literature review; 13 studies, 241 patients)
- Tranexamic Acid - Drug Summary. Prescribers' Digital Reference. Accessed September 1, 2021. (Medication package insert)
- Gestational hypertension and pre-eclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020;135(6):e237-e260. (Practice guideline)
- Vermillion ST, Scardo JA, Newman RB, et al. A randomized, double-blind trial of oral nifedipine and intravenous labetalol in hypertensive emergencies of pregnancy. Am J Obstet Gynecol. 1999;181(4):858-861. (Randomized double-blind trial; 50 patients)
- Raheem IA, Saaid R, Omar SZ, et al. Oral nifedipine versus intravenous labetalol for acute blood pressure control in hypertensive emergencies of pregnancy: a randomised trial. BJOG. 2012;119(1):78-85. (Randomized double-blind trial; 50 patients)
- Bateman BT, Patorno E, Desai RJ, et al. Late pregnancy blocker exposure and risks of neonatal hypoglycemia and bradycardia. Pediatrics. 2016;138(3):e20160731. (Retrospective cohort; 10,585 patients)
- Magee LA, Miremadi S, Li J, et al. Therapy with both magnesium sulfate and nifedipine does not increase the risk of serious magnesium-related maternal side effects in women with pre-eclampsia. Am J Obstet Gynecol. 2005;193(1):153-163. (Retrospective chart review; 377 patients)
