CPG - Bimanual Compression

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2012 CPM

Bimanual Compression - Definition PPH

PPH = Primary post partum haemorrhage.
- Occurs within 24hrs of delivery
- Bleeding from or into the genital tract
- >500ml or sufficient to cause deterioration of mother's condition

Bimanual Compression Indications

- Significant PV bleed
- Enlarged soft uterus
- Tachycardia
- Restlessness
- Profound hypotension

Bimanual Compression Contraindications

Nil

Bimanual Compression Complications

- Trauma
- Pain

PPH Management ?Trauma induced

- Urgent transport
- Thorough assessment inc. estimated blood loss
- Locate source of bleeding and apply pressure externally with sterile dressing
- Encourage mother to empty bladder (contractions inhibited by full bladder)
- Encourage neonate to suckle
- Consider appropriate fluid resus
- Consider medical retrieval for blood products/oxytocic drugs

PPH Management ?hypotonicity/retained products of conception

- Massage uterus/fundus in circular motion to stimulate contractions & remove blood & clots
- Encourage mother to empty bladder (contractions inhibited by full bladder)
- Encourage neonate to suckle
- Consider appropriate fluid resus
- Consider medical retrieval for blood products/oxytocic drugs

Methods for torrential/uncontrollable haemorrhage

1 - External aortic compression
2 - Bimanual compression

External aortic compression advantages

- Quicker
- No aseptic precautions
- No consult

External aortic compression procedure

- Apply downward pressure to abdominal aorta (above umbilicus to the left) with closed fist
- Check adequacy of compression by palpating femoral pulse
- If femoral pulse palpable, check position, exert more pressure
- Maintain compression until bleeding controlled

Bimanual compression procedure considerations

- Difficult
- Extremely painful
- Performed on consult

Bimanual compression procedure

- Wash and scrub hands
- Insert gloved, lubricated hand into vagina
- Form fist in anterior vaginal fornix
- Apply pressure against anterior wall of uterus
- Push other hand deeply into abdomen behind fundus, applying pressure against posterior uterine wall
- Maintain compression until bleeding is controlled and uterus contracts

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