Essential Contents of a Postpartum Hemorrhage (PPH) Tray
A comprehensive postpartum hemorrhage tray should include medications, blood collection equipment, and monitoring tools to enable rapid assessment and management of bleeding to reduce maternal morbidity and mortality.
Medications
- Oxytocin 10 IU for IM/IV administration as first-line uterotonic for prevention and treatment of PPH 1
- Tranexamic acid 1g IV (to be administered over 10 minutes) within 3 hours of bleeding onset 2
- Methylergonovine 0.2 mg for IM administration (contraindicated in hypertension) 3
- Carboprost tromethamine (Hemabate) 250 mcg for IM administration 4
Blood Collection and Measurement Equipment
- Calibrated blood-collection drape for accurate measurement of blood loss 5
- Volumetric and gravimetric measurement tools for cumulative blood loss assessment 5
- Large-bore IV access equipment (16-18 gauge catheters) 2
Monitoring Equipment
- Equipment for vital signs monitoring 2
- Point-of-care testing devices for hemostatic assessment (if available) 5
- Blood sampling tubes for coagulation studies, complete blood count, and fibrinogen levels 5
Fluid Resuscitation Equipment
- IV fluid administration sets 2
- Fluid warming equipment to maintain patient temperature >36°C 6
- Rapid infusion devices for emergency situations 2
Blood Component Therapy Supplies
- Blood product administration sets 2
- Blood filters 5
- Cell salvage equipment with leukocyte filter (if available for cesarean deliveries) 5
Mechanical Interventions
- Intrauterine balloon tamponade device 5
- Uterine compression suture materials 2
- Bimanual compression equipment 7
Procedural Equipment
Documentation Tools
- PPH management protocol/checklist 2
- Blood loss recording chart 5
- Communication tools for team coordination 2
Important Considerations
- Early recognition of bleeding with accurate measurement is crucial, as visual estimation of blood loss is often inaccurate 5
- Hypofibrinogenemia (fibrinogen <2 g/L) is the most common factor deficiency in PPH and should be monitored closely 5
- A FIBTEM A5 value <12 mm on viscoelastic testing (if available) can predict progression to severe hemorrhage 5
- Platelet transfusion is rarely required unless PPH exceeds 5000 ml or platelet count is <75 × 10^9/L 5
- Tranexamic acid should be administered within 3 hours of bleeding onset for maximum effectiveness 2
Common Pitfalls to Avoid
- Delaying administration of uterotonics - oxytocin should be given immediately when PPH is identified 7
- Underestimating blood loss due to visual assessment - always use calibrated measurement tools 5
- Waiting for laboratory results before initiating blood component therapy in severe bleeding 5
- Excessive crystalloid fluid administration which can worsen coagulopathy 8
- Failing to maintain normothermia, which can worsen coagulopathy 6
Remember that early identification and prompt, coordinated response to PPH are essential for preventing progression to severe hemorrhage and reducing maternal mortality 9.