UTERINE ATONY

  • Do a bimanual uterine massage and express any clots; this may also provoke contractions.
  • Put up an oxytocin drip 20 units in 500ml dextrose or normal saline to run at 20 drops per minute for about 2 hours.
  • Give prostaglandins when and where available, as these are also useful:
    • Misoprostrol 600mcg orally or per rectum.
  • Surgery:
    • Subtotal hysterectomy if above measures do not achieve haemostasis.