Have patient estimate the number of pads soaked per hour. Determine when bleeding began.
Prepare to treat for shock.
Transport emergent in left lateral recumbent position if ≥ 20 weeks gestation or if uncontrollable bleeding is present.
ALS
Establish 2 large bore IV’s of 0.9% NaCl or LR. LR should not be used in blood products are being transfused in the same line. Titrate fluids to a SBP of 90 mmHg.
Any pregnant or recently delivered (within 4 weeks) woman with the presence of hypertension (BP >140/90) and possibly marked edema of the face, hands, and/or feet.
Massage the fundus of the uterus after delivery of the placenta until firm. Check fundus every 5 minutes for firmness and repeat massage as necessary.
ALS
Insert 2 large bore IV's with normal saline or LR and run wide open to maintain a SBP of 90 mm Hg. Do not use LR if blood products are being given in the same line.
Contact receiving facility as early as possible. Activate as a medical alert if blood Loss >500ml, HR ≥110 BPM, Systolic BP ≤90mmHg or SPO2 < 94%.