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PPH Protocol (FIGO)

Obstetric Shock Index

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

01

Immediate Actions

  • Help • Oxygen • 2x LBIV
  • Tone/Tissue/Trauma/Thrombin
  • Bimanual Compression
02

Pharmacotherapy

  • OXTY 40 IU INFUSION
  • TXA 1g IV (Within 3h)
03

Refractory Care

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

Guidelines & Evidence

Verified

Last Review: 2026

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.

Last Comprehensive Review: 2026