Peripartum life-threatening haemorrhage - 2018


You are called as an anaesthetist to the delivery room to the 30 years old woman in labour (V-gravida, III-para). The delivery was physiological in term, performed in epidural analgesia, common blood loss during the birth (I. stage of labour 8 hours, II. stage of labour 10 minutes), the boy was delivered (3950 g, 52 cm, Apgar score 8-10-10). At the beginning of third stage of labour strong bleeding from genitals appears, there is a blood loss of 500 mL within 5 minutes. Shortly after the delivery of the placenta, the patient is conscious, pale, tachycardic, free of signs of respiratory insufficiency. What will be your next step?

Oxygen therapy is not indicated, obtain 2 peripheral vein accesses, and monitor basic life functions.

Wrong answer

Every pre-shock state requires oxygen therapy.


Always intubate the patient and give oxygen, obtain 2 peripheral vein accesses and monitor basic life functions.

Wrong answer

The patient is at the moment conscious and doesn’t have any signs of respiratory insufficiency. Currently, there is no indication for intubation (indicated once GCS drops below 8).


Give oxygen via face mask, obtain 2 peripheral vein accesses and administer 4-6 TU of FFP, monitor basic life functions.

Wrong answer

Administration of 4-6 TU FFP without obvious coagulation disorder is not indicated.


Obtain 2 peripheral vein accesses, give oxygen via face mask, monitor vital functions (in case of loss of consciousness, intubate in time).

Correct answer

For each pre-collapse state are external vein accesses, giving oxygen and basic life functions monitoring priority.




ACT – activated clotting time TT – trombin time FBG – fibrinogen TEG – trombelastogram FFP – fresh frozen plasma AT III – antithrombin III GCS – Glasgow Coma Scale DIC – disseminated intravascular coagulation TU – transfusion unit mL - mililiter IV - intravenous IM - intramuskular×

20 bpm


111 bpm


89 %


85/55 mmHg


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