PPH Protocol (FIGO)

Obstetric Shock Index

Heart Rate (bpm)

Systolic BP (mmHg)

Visual EBL Reference

Full Kidney Dish≈ 500mL

10x10cm Swab (Soaked)≈ 60mL

Large Inco-pad (Soaked)≈ 250mL

Sanitary Towel (Soaked)≈ 100mL

FIGO PPH Protocol (Updated)

Universal Emergency Response Framework

Immediate Actions

Help • Oxygen • 2x LBIV
Tone/Tissue/Trauma/Thrombin
Bimanual Compression

Pharmacotherapy

OXTY 40 IU INFUSION
TXA 1g IV (Within 3h)

Refractory Care

Uterine Balloon (UBT) • NASG Garment • Surgery. If Shock Index persists > 1.1 → ACTIVATE MTP.

Guidelines & Evidence

Verified

Last Review: 2026-07-17

When to Use

Definition & Recognition

Cumulative blood loss ≥1,000 mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process (includes intrapartum loss) regardless of route of delivery.

When to Activate Protocol

Cumulative blood loss >500 mL in vaginal delivery or >1000 mL in Cesarean (Stage 1).

Vital sign instability (HR >110, BP <85/45, O2 sat <95%).

Visible brisk bleeding or boggy uterus unresponsive to initial massage.

Patient symptomatic of hypovolemia (lightheadedness, tachycardia, pallor).

Risk Factors

Tone: Polyhydramnios, macrosomia, multiple gestation, chorioamnionitis.

Tissue: Retained placenta, placenta accreta spectrum.

Trauma: Episiotomy, lacerations, uterine inversion/rupture.

Thrombin: Abruption, preeclampsia, known coagulopathy.

How it Works

The 4 T’s of PPH

Tone (Atony)	70–80% of cases
Tissue (Retained products)	10% of cases
Trauma (Lacerations/Inversion)	20% of cases
Thrombin (Coagulopathy)	<1% of cases

First-Line Uterotonics

Oxytocin (Pitocin)	10–40 units per 500–1000 mL IV or 10 units IM
Methylergonovine (Methergine)	0.2 mg IM (Avoid in HTN/Preeclampsia)
15-methyl PGF2α (Hemabate)	250 mcg IM (Avoid in Asthma)
Misoprostol (Cytotec)	600–1000 mcg PR, SL, or PO
Tranexamic Acid (TXA)	1g IV over 10 min (Best if given within 3 hrs)

Last Comprehensive Review: 2026-07-17

In Recent Clinical News

Scanning Medical Journals

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PPH Protocol (FIGO)

Obstetric Shock Index

Visual EBL Reference

FIGO PPH Protocol (Updated)

When to Use

Definition & Recognition

When to Activate Protocol

Risk Factors

How it Works

The 4 T’s of PPH

First-Line Uterotonics

Clinical Pearls

Practical Pearls

Critical Contraindications

Next Steps

Stage 1: Recognition & Initial Management

Stage 2: Refractory PPH (Blood Loss <1500 mL)

Stage 3: Massive Hemorrhage (>1500 mL or Instability)

The Evidence

Core Guidelines

Practice Bulletin No. 183: Postpartum Hemorrhage.

The WOMAN Trial

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage.

AWHONN Safety Bundle

Origins & History

Development of Modern Protocols

The CMQCC Influence

In Recent Clinical News

PPH Protocol (FIGO)

Obstetric Shock Index

Visual EBL Reference

FIGO PPH Protocol (Updated)

When to Use

Definition & Recognition

When to Activate Protocol

Risk Factors

How it Works

The 4 T’s of PPH

First-Line Uterotonics

Clinical Pearls

Practical Pearls

Critical Contraindications

Next Steps

Stage 1: Recognition & Initial Management

Stage 2: Refractory PPH (Blood Loss <1500 mL)

Stage 3: Massive Hemorrhage (>1500 mL or Instability)

The Evidence

Core Guidelines

Practice Bulletin No. 183: Postpartum Hemorrhage.

The WOMAN Trial

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage.

AWHONN Safety Bundle

Origins & History

Development of Modern Protocols

The CMQCC Influence

In Recent Clinical News