Pre-referral management of PPH
You should remember that any amount of active (fresh or bright red) vaginal bleeding after 24 hours may be due to one of the causes listed earlier, or others not mentioned. Therefore, you should refer these women to a hospital regardless of the amount of bleeding. You should also remember that if the bleeding is severe, only a blood transfusion can save the life of the mother.
What do you to do before referring a women with PPH?
Put up an intravenous (IV) line, and start the woman on intravenous fluid therapy with Ringer's Lactate or Normal Saline, using a 1,000 ml (1 litre) bag and a flow rate set to run as fast as possible.
As a pre-referral treatment, you should also give her a second dose of misoprostol (400 micrograms orally or rectally), or oxytocin 10 IU (International Units) by intramuscular injection.