Volume replacement

1. Patients with postpartum hemorrhage that is refractory to medical therapy require a second large-bore IV catheter. If the patient has had a major blood group determination and has a negative indirect Coombs test, type-specific blood may be given without waiting for a complete cross-match. Lac-tated Ringer's solution or normal saline is generously infused until blood can be replaced. Replacement consists of 3 mL of crystalloid solution per 1 mL of blood lost.

2. A Foley catheter is placed, and urine output is maintained at greater than 30 mL/h.

G. Surgical management of postpartum hemorrhage. If medical therapy fails, ligation of the uterine or uteroovarian artery, infundibulopelvic vessels, or hypogastric arteries, or hysterectomy may be indicated.

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