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OB/GYN
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hard
Postpartum Hemorrhage (Atony)
Flowchart
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Step-wise: massage, TXA, uterotonics, balloon, surgery.
Decision
Outcome
Decision
PPH + soft boggy uterus. Step 1?
✓
Uterine massage + high-dose oxytocin
✗
Hysterectomy first
Decision
Step 2 (if bleeding continues)?
✓
Tranexamic acid 1 g IV
Decision
Step 3 — second-line uterotonics?
✓
Methylergonovine (CI: hypertension)
✓
Carboprost tromethamine (CI: asthma)
✓
Misoprostol
Decision
Still bleeding — Step 4?
✓
Intrauterine balloon tamponade (Bakri)
Decision
Persistent bleeding — Step 5?
✓
Laparotomy (uterine artery ligation, B-Lynch suture, uterine artery embolization, hysterectomy)
Outcome
Surgical control — embolization or hysterectomy is final option
PPH = estimated blood loss ≥1000 mL or bleeding with hypovolemia.