Obstetric Emergencies

Postpartum Haemorrhage (PPH)

IN REVIEWv4🇮🇳 India-firstPENDING CLINICAL VERIFICATION⚡ Postpartum Haemorrhage ⚡ Massive Transfusion Activation

Recognise PPH early: measured loss ≥500 mL, or ≥300 mL with abnormal haemodynamics; treat concerning ongoing bleeding/shock immediately. Resuscitation, uterotonics, early TXA and 4Ts source control proceed together, with timely tamponade or surgery.

Admission & discharge ↓

Reviewer note: Medication regimens and dependent emergency instructions checked 17 October 2026. These targeted checks do not certify every statement in the module. Admission/discharge guidance checked 18 October 2026. This adds a scoped clinical synthesis and does not certify every statement in the module.

Admission & discharge

Care setting: Emergency admission; major bleeding may need theatre/critical care

Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.

When admission or continued hospital care is needed

Admit and treat ongoing heavy bleeding, abnormal haemodynamics, suspected retained tissue/infection or coagulopathy. Transfer to theatre/critical care according to bleeding and organ-support requirements.

When clinic, day care or home care may be suitable

Active PPH, shock or suspected secondary PPH with systemic illness is not suitable for routine outpatient management.

Before going home

The bleeding source is controlled; uterine/perineal/wound assessment is satisfactory and there is no recurrent concerning loss.
Haemodynamics, consciousness, urine output, oral intake, mobility and pain control support home care. Review anaemia symptoms, Hb trend and any coagulopathy/organ injury; there is no single Hb value that alone certifies safe discharge.

Discharge medicines and treatment changes

Prescribe iron replacement when iron deficiency/anaemia is present, using a documented formulation, dose and response plan; assess whether IV treatment or transfusion is needed before discharge.
Uterotonics and TXA used for the acute event are not automatically continued at home. Reassess VTE prophylaxis after bleeding risk has fallen.

Medicine doses — use only when indicated

Use the medicines selected for this patient. Listed alternatives are not instructions to prescribe all of them together. Confirm the actual remaining course, pregnancy/postnatal context and monitoring plan.

Only for diagnosed postpartum iron-deficiency anaemia after bleeding is controlled.

Oral iron and folic acid — postpartum anaemia treatmentWHO / FIGO / ICM · 2025 consolidated recommendations, supportive care tablesummary checked

Dose120 mg ELEMENTAL iron plus 400 micrograms folic acid per day

RouteOral

FrequencyDaily; tailor administration for tolerance without accidentally changing the prescribed total

DurationWHO postpartum anaemia treatment: until Hb normalises. Then document any continuing preventive/repletion course and review; the preventive 6–12-week recommendation is a different indication.

PreparationUse the product’s ELEMENTAL iron content, not salt weight: two tablets each containing 60 mg elemental iron provide 120 mg. Check the combined-tablet folate separately. Separate iron from calcium by several hours and levothyroxine by 4–5 hours.

Max dose120 mg/day elemental iron in this WHO treatment schedule; do not add duplicate antenatal/OTC iron or overlap oral and IV courses without an explicit plan.

Indication: Diagnosed postpartum iron-deficiency anaemia after haemorrhage is controlled and outpatient oral treatment is suitable
The WHO 2025 supportive-care recommendation supplies the postpartum dose/endpoint. Preparation and response monitoring reuse the checked oral-iron reference; breastfeeding is compatible with indicated maternal supplementation.

Monitoring

Arrange Hb response review after 2–4 weeks, tolerance and adherence; investigate non-response or ongoing bleeding and reassess the replacement route.
Review the cause of anaemia and any coexisting B12/folate deficiency or haemoglobinopathy.

Contraindications: Iron overload or anaemia without iron deficiency; oral iron alone is inadequate for unstable bleeding or cardiovascular compromise.

Tests, pending results and their reviewer

Record quantified loss, procedures, transfusion and latest relevant CBC/coagulation/renal results; assign a reviewer/date for outstanding investigations.

Home care and counselling

Explain the cause and treatment, expected lochia, worsening-bleeding warnings, fatigue/feeding support and the future-birth haemorrhage plan. Offer a debrief and emotional support.

Follow-up: when and what to review

When	Action / responsible service
Before leaving	Book anaemia/Hb response review and communicate any organ-injury or transfusion follow-up to the responsible team.
Early postnatal contacts and 6-week review	Review bleeding, recovery, mental health and the future-pregnancy plan; review sooner for symptoms or major anaemia.

Return urgently

Sudden/heavy or increasing bleeding, fainting, breathlessness, fever, offensive discharge or worsening abdominal pain require immediate assessment.

Open the complete discharge checklist →

Sources for this plan:

MSFchecked NICE · NG194, recommendationschecked India MoHFW / NHM · LaQshya district-hospital SOP, linked editionchecked WHO · 2022 official recommendation summarychecked WHOsummary checked WHO / FIGO / ICM · 2025 consolidated recommendations, supportive care tablesummary checked

Treatment

① Immediate stabilization — first minutes

Resuscitate and identify the cause IN PARALLEL: two large-bore IV cannulae, bloods/crossmatch and quantified cumulative loss; oxygen for hypoxia/shock, active warming and monitored fluid/blood replacement.
Massage the uterus and use bimanual compression for atony; empty the bladder with a Foley catheter and measure urine output.
Give oxytocin loading plus infusion and TXA using the complete cards below. Record previous prophylactic uterotonics: their identity changes the next uterotonic choice.
For ongoing ATONIC bleeding, choose an appropriate additional uterotonic now: avoid ergometrine/methylergometrine with hypertension or pre-eclampsia, and avoid carboprost with asthma/significant pulmonary disease. Do not give both ergot preparations as though they are interchangeable.
Keep examining the 4Ts while drugs are administered. Do not wait to finish eight carboprost doses before preparing tamponade or surgery in ongoing haemorrhage.

③ First-line treatment & drug regimens

Oxytocin — treatment of atonic PPHMSFchecked

Dose5–10 IU slowly IV, then 20 IU in 1 L isotonic crystalloid over 2 hours (MSF regimen)

RouteSlow IV loading + IV infusion

FrequencyLoading followed immediately by infusion

DurationInitial infusion over 2 h; reassess continuously and prescribe further treatment according to response

PreparationWith 10 IU/mL stock, 20 IU = 2 mL added to 1 L sodium chloride 0.9% or Ringer lactate. Pump 500 mL/hour = 10 IU/hour. Include this litre in total resuscitation fluid

Max doseMSF maximum total oxytocin 60 IU; avoid rapid boluses and excessive fluid

Atonic bleeding after delivery; treatment continues alongside the PPH bundle

Monitoring

Quantified blood loss, uterine tone, BP/pulse, perfusion and urine output; record every dose and time
Persistent shock or bleeding needs source control and blood products in parallel; do not wait for all drug doses
Fluid balance, sodium if prolonged/high-volume treatment; cardiac disease needs a separately prescribed concentrated infusion

Contraindications: Rapid IV injection can cause hypotension/tachycardia · Monitor fluid overload, especially pre-eclampsia or cardiac disease

Tranexamic acid — PPHWHO · Supersedes 2012 TXA recommendation; now folded into Consolidated PPH 2025 Recs 27/29checked

Dose1 g IV over 10 min; repeat 1 g if bleeding continues after 30 min OR restarts within 24 h

RouteIV only

FrequencyOne initial dose; at most one additional 1 g dose under those criteria

DurationAcute PPH treatment, maximum 2 doses in this regimen

Preparation100 mg/mL: 1 g = 10 mL. Give no faster than 1 mL/min, or dilute in compatible sodium chloride 0.9% and infuse over 10 min. Clearly label IV ONLY; never intrathecal

Max dose2 g total. The 24 h repeat rule does NOT permit a first dose after the 3 h window

PPH of any cause; first dose as soon as possible and WITHIN 3 h of birth
Renal / hepatic: Renal clearance: assess renal function and seek dose advice with impairment; do not repeatedly dose without review

Monitoring

Quantified blood loss, uterine tone, BP/pulse, perfusion and urine output; record every dose and time
Persistent shock or bleeding needs source control and blood products in parallel; do not wait for all drug doses

Contraindications: Clear contraindication to antifibrinolysis, such as a known thromboembolic event during pregnancy; renal dysfunction needs dose review

Methylergometrine (methylergonovine)Manufacturer prescribing information / DailyMedchecked

Dose0.2 mg (200 micrograms)

RouteIM

FrequencyMay repeat after 2–4 h if necessary, following reassessment

DurationAcute treatment after birth; do not prescribe repeated doses while delaying haemorrhage control

Preparation0.2 mg/mL: 1 mL IM. Check the ampoule for the actual drug name. Routine IV use is avoided because of sudden hypertension/stroke risk

Max dose0.2 mg per injection; further doses require documented reassessment. No invented 15-minute repeat course

Atonic PPH after delivery; this is NOT the same formulation/dose as ergometrine
The product label advises no breastfeeding during treatment and for at least 12 h after the last dose; express/discard milk during that interval.

Monitoring

Quantified blood loss, uterine tone, BP/pulse, perfusion and urine output; record every dose and time
Persistent shock or bleeding needs source control and blood products in parallel; do not wait for all drug doses
BP before each dose; chest pain, vasospasm, headache and neurological symptoms

Contraindications: Hypertension/pre-eclampsia/eclampsia; vascular or significant cardiac disease; before delivery of the last baby · Avoid strong CYP3A4 inhibitors; do not combine ergot preparations

Ergometrine maleateManufacturer / emcchecked

Dose200–500 micrograms IM; severe haemorrhage option 250–500 micrograms slow IV by a senior clinician

RouteIM; slow IV only for severe haemorrhage

FrequencyInitial dose followed by reassessment; select another indicated intervention for continuing bleeding

DurationAcute post-birth treatment; no routine multi-day course in this emergency row

Preparation500 micrograms/mL formulation: 500 micrograms = 1 mL. For IV use the cited label permits dilution to 5 mL with sodium chloride 0.9%; administer slowly with BP monitoring

Max dose500 micrograms per dose in this label; do not substitute the methylergometrine schedule or invent a cumulative ceiling

Alternative uterotonic for atonic PPH; use this row only when the ampoule is ERGOMETRINE

Monitoring

Quantified blood loss, uterine tone, BP/pulse, perfusion and urine output; record every dose and time
Persistent shock or bleeding needs source control and blood products in parallel; do not wait for all drug doses
BP before and after injection; chest pain, severe headache, peripheral ischaemia

Contraindications: Hypertension/pre-eclampsia/eclampsia, severe cardiac/vascular disease, severe renal/hepatic impairment · Never use before delivery of the last baby

CarboprostManufacturer prescribing information / DailyMedchecked

Dose250 micrograms (0.25 mg) deep IM

RouteIM only

FrequencyRepeat according to response at intervals of 15–90 min; NEVER sooner than 15 min

DurationAcute rescue; ongoing bleeding requires parallel tamponade/surgery

Preparation250 micrograms/mL: draw 1 mL undiluted. Verify units carefully: micrograms, not milligrams. Do not administer IV

Max dose2 mg total = 8 doses of 250 micrograms

Refractory atonic PPH after first-line uterotonic; do not use for trauma or retained tissue alone

Monitoring

Quantified blood loss, uterine tone, BP/pulse, perfusion and urine output; record every dose and time
Persistent shock or bleeding needs source control and blood products in parallel; do not wait for all drug doses
Respiratory status/bronchospasm, BP, vomiting/diarrhoea

Contraindications: Asthma or significant active pulmonary disease; active cardiac, renal or hepatic disease · Do not persist with repeated injections in a deteriorating patient

Misoprostol — PPHMSFchecked

Dose800 micrograms

RouteSublingual; rectal if sublingual administration is not feasible

FrequencySingle rescue dose

DurationOne acute dose; arrange further haemorrhage control if bleeding continues

PreparationFour 200-microgram tablets = 800 micrograms; place under the tongue. Do not confuse this with the 25-microgram labour-induction dose

Max dose800 micrograms in this rescue regimen; do not automatically repeat

Atonic PPH when IV oxytocin is unavailable or bleeding does not respond; additional uterotonic selection depends on drugs already given

Monitoring

Quantified blood loss, uterine tone, BP/pulse, perfusion and urine output; record every dose and time
Persistent shock or bleeding needs source control and blood products in parallel; do not wait for all drug doses
Temperature, shivering, gastrointestinal effects; distinguish drug fever from ongoing sepsis

Contraindications: Do not use PPH dosing before birth of the baby

Non-drug treatment

Bimanual compression while preparing next step
Non-pneumatic anti-shock garment (NASG) where available for transfer/stabilisation
Warming (blankets/fluids) — hypothermia worsens coagulopathy
Keep cumulative tally on whiteboard: EBL, products given, vitals timeline

Definitive treatment

TONE: continue bimanual compression and the selected uterotonics. TRAUMA: inspect and repair tears/haematoma; assess rupture/inversion. TISSUE: arrange skilled manual removal/evacuation when indicated; do not forcibly detach a suspected accreta placenta. THROMBIN: correct coagulopathy with the blood bank while obtaining source control.
If atony continues despite initial treatment, consider intrauterine balloon tamponade only after assessing trauma/retained tissue and where monitoring, blood and immediate surgical rescue are available. Use sterile technique, the specific balloon’s recommended filling fluid/volume and a drainage channel; record fill volume and continuing blood loss.
Bakri-type devices have a manufacturer-specific maximum volume (commonly 500 mL); do not inflate repeatedly beyond the device limit to compensate for persistent bleeding. Continue observations, uterotonic support and an explicitly prescribed antibiotic/removal plan.
Persistent bleeding, deteriorating physiology or a failed tamponade test means immediate senior operative control. Compression sutures/devascularisation, embolisation in a stable suitable patient, or hysterectomy are selected by cause and expertise; this is not a mandatory ladder requiring every step before hysterectomy.

Monitoring

Parameter	During active major bleeding	Action / goal
Blood loss, uterine tone, BP/pulse, perfusion, consciousness	Continuous/frequent reassessment with recorded trend	Continuing loss or shock → escalate source control immediately
Urine output	Hourly via catheter	Target ≥0.5 mL/kg/h; interpret with overall perfusion
CBC/platelets, PT/APTT, fibrinogen	Repeat during ongoing loss and after component replacement	Fibrinogen ≥2 g/L; platelets generally >50×10⁹/L during major bleeding
Blood gas/lactate, ionised calcium, potassium, temperature	Serially during rapid transfusion	Correct abnormalities and maintain normothermia; no undefined calcium prescription

Response assessment

Bleeding slowing; firm uterus; balloon holding without refill
Vitals normalising; urine output recovering
Coags correcting; no progressive oozing

Treatment failure

Continuing loss or shock despite initial treatment: theatre and major-haemorrhage support immediately, without an arbitrary waiting period.

HDU/ICU for ongoing shock, vasopressor/ventilation need, coagulopathy, organ dysfunction or large transfusion; a unit count is not the sole admission criterion.

During transfer, continue uterine/aortic compression as appropriate, warming and blood/fluid support with skilled escort; contact the receiving team first. Compression/tamponade must not delay transfer or definitive rescue.

Second-line treatment

Refractory coagulopathy needs senior haemostatic assessment, appropriate fibrinogen/platelet/plasma replacement and source control; haemostatic rescue agents are not substitutes for these measures.

Rescue treatment

Activate major-haemorrhage support and definitive operative control early. If arrest occurs, follow maternal ALS with manual uterine displacement and immediate preparation for resuscitative birth at the arrest location.

Procedure / surgery

See procedures-mva (retained tissue), procedures-balloon-tamponade, procedures-blynch, procedures-peripartum-hysterectomy pages.

Escalation

Continuing loss or shock despite initial treatment: theatre and major-haemorrhage support immediately, without an arbitrary waiting period.

HDU/ICU for ongoing shock, vasopressor/ventilation need, coagulopathy, organ dysfunction or large transfusion; a unit count is not the sole admission criterion.

⑮ Complications & their management

DIC / dilutional coagulopathy

Ratio-based component therapy; fibrinogen replacement target ≥2 g/L; avoid FFP-only loops; recheck q1h

Dilutional thrombocytopenia

Platelets 1 pool per 6–8 units RBC or when <50×10⁹/L bleeding

Hypocalcaemia/hypothermia/acidosis (lethal triad partners)

Ionised Ca correction; active warming; ventilatory support for acidosis

Acute kidney injury

Volume restoration priority; avoid nephrotoxins; dialysis if AEIOU

Sheehan syndrome (late)

Post-event pituitary screen: prolactin/FT4/cortisol if lactation failure/fatigue; endocrinology referral

Secondary PPH

US for RPOC ± sepsis screen; antibiotics if infected; evacuation (MVA) with sepsis precautions; rare: GTN — send βhCG if persistent

Post-treatment care

Anaemia correction: oral/IV iron per anaemia module; transfuse if symptomatic/Hb<70
Thromboprophylaxis reassessed AFTER haemostasis (high VTE risk category)
Lactation support; psychological debrief (PPH is traumatic)
Document timeline + products + decisions; incident reporting/MTP audit
Follow-up Hb check 2 weeks; contraception discussion delayed until stable

Diagnosis & assessment

Red flags:

SHOCK INDEX (HR÷SBP) ≥0.9 — early hypovolaemia marker
BP falling / HR rising / pallor-sweating
Continued ooze with "normal" vitals in anaemic women (Hb<8 masks collapse)
Boggy uterus despite massage
Bleeding continuing after uterine contraction achieved → trauma/tissue/coagulopathy
Oliguria <0.5 mL/kg/h

Definition: WHO 2025 adds the treatment trigger of ≥300 mL blood loss with abnormal vital signs to the traditional ≥500 mL threshold. Do not wait for 1000 mL after caesarean, a low Hb, or every classic shock sign before treating a deteriorating patient.

Risk factors

Previous PPHPlacenta praevia/accretaMultiple pregnancyPolyhydramniosAnaemia (Hb<9 g/dL)GrandmultiparityObesityBleeding disorder / anticoagulantsIntrapartum: prolonged labour (oxytocin use)Precipitate labourOperative vaginal birthCaesarean esp. emergencyChorioamnionitisRetained placentaMgSO4 therapySevere anaemia

Initial assessment

CALL FOR HELP — declare "PPH"; activate unit protocol; note time zero
ABC: high-flow O₂ if shocked; position flat/left-lateral
Two large-bore (14–16G) IV cannulae; send: CBC, crossmatch, coagulation (+fibrinogen), renal/liver, lactate where available
Quantify blood loss (calibrated drape/weigh swabs) — visual estimation underestimates by 30–50%
Palpate uterus → ATONIC? start massage immediately
Empty bladder (catheter)
Start crystalloid + oxytocin infusion while assessing cause (4Ts: Tone/Trauma/Tissue/Thrombin)

Investigation	Purpose
CBC + platelets (repeat q1–2h if major)	Baseline + trend; transfuse thresholds
Group & save/CROSSMATCH	Component availability; MTP if ongoing
PT/APTT/Fibrinogen (fibrinogen FIRST to fall in OB DIC)	Coagulopathy detection before overt oozing
Lactate/ABG/ionised calcium	Shock depth; transfusion-related hypocalcaemia
Bedside US	Retained tissue/free fluid; NOT a delay to treatment

Life-saving resuscitation must NEVER wait for lab results — treat the patient, confirm with labs.

Differential diagnosis

Condition	Clue
Uterine atony (70–80%)	Soft boggy uterus; contracts with massage
Genital tract trauma	Firm uterus + bright continuous bleeding — inspect cervix/vagina/perineum
Retained tissue/placenta	Incomplete placenta/membranes; US shows retained products
Coagulopathy/DIC	Oozing from IV sites, no formed clot; low fibrinogen first to fall
Uterine inversion	Fundus not palpable/dimpled; mass at introitus (see emergency)
Uterine rupture	Prior scar + fetal parts superficial + shock + CTG catastrophe

Algorithm

Entry point≥500 mL loss OR ≥300 mL with abnormal haemodynamics; treat shock/ongoing concerning bleeding immediately

ActionCALL HELP · time zero · roles assigned

Next2×16G IVs · bloods+crossmatch · quantify loss · catheter ↓

Action2×16G IVs · bloods+crossmatch · quantify loss · catheter

NextUterus soft? ↓

DecisionUterus soft?

YES (atony)MASSAGE + oxytocin bolus&infusion + 2nd uterotonic + TXA 1g ↓NOEXAMINE THEATRE CONDITIONS: tears? tissue? clotting? inversion? rupture? ↓

ActionMASSAGE + oxytocin bolus&infusion + 2nd uterotonic + TXA 1g

NextBleeding controlled in 10–15 min? ↓

DecisionBleeding controlled in 10–15 min?

YESContinue MTP if needed · ICU review · debrief · iron/VTE plans ↓NOBALLOON TAMPONADE (fill till stops) ↓

ActionEXAMINE THEATRE CONDITIONS: tears? tissue? clotting? inversion? rupture?

NextRepair/remove/correct — recheck tone loop ↓

ActionRepair/remove/correct — recheck tone loop

NextBleeding controlled in 10–15 min? ↓

ActionBALLOON TAMPONADE (fill till stops)

NextBalloon holds? ↓

DecisionBalloon holds?

YES → observe 6–24hContinue MTP if needed · ICU review · debrief · iron/VTE plans ↓NO/refillsLAPAROTOMY: B-Lynch → vessel ligation → HYSTERECTOMY decision ↓

OutcomeLAPAROTOMY: B-Lynch → vessel ligation → HYSTERECTOMY decision

OutcomeContinue MTP if needed · ICU review · debrief · iron/VTE plans

Principles & follow-up

Management principles

Follow-up

Hb recheck day 3 & 2 weeks
Lactation/psychological support
Future-pregnancy risk counselling + birth plan in equipped unit

Patient education

Danger signs at home: heavy clots/soaking pad hourly, dizziness, fainting → return immediately

Sources (19)

WHO / FIGO / ICM — Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
2025-10 · checked 2026-10-17 · verified-summary
Open source ↗

Targeted recheck: WHO 2025 recognition/treatment trigger (≥500 mL or ≥300 mL with abnormal haemodynamics), concurrent first-response bundle and refractory-haemorrhage fibrinogen target ≥2 g/L if replacing a level <2 g/L. Primary recommendation chapter/table indexed at https://www.ncbi.nlm.nih.gov/bo…

WHO — WHO recommendation on tranexamic acid for the treatment of postpartum haemorrhage (WOMAN-trial based)
2017 · checked 2026-10-17 · verified-live
Open source ↗

TXA 1 g IV over 10 minutes within three hours of birth; repeat 1 g for bleeding continuing at 30 minutes or recurring within 24 hours. The recurrence rule is for a second dose and does not permit a first dose beyond three hours. WHO 2025 recommendation text and original WHO dosing reviewed.

WHO — WHO recommendations on the assessment of postpartum blood loss and use of a treatment bundle for postpartum haemorrhage
2023 · checked 2026-08-23 · verified-summary
Open source ↗

WHO landing page; detailed wording pending full-text audit — flagged in module

WHO — WHO recommendations: Uterotonics for the prevention of postpartum haemorrhage
2018-12 · checked 2026-08-23 · verified-summary
Open source ↗

Landing page; dose specifics via Consolidated 2025 chapter + provider guide (oxytocin 10 IU IM/IV)

WHO — Global health agencies issue new recommendations on postpartum haemorrhage — 5 October 2025
· checked 2026-10-17 · verified-live
Open source ↗

Earlier PPH treatment trigger: ≥300 mL with abnormal vital signs in addition to the traditional 500 mL threshold; avoid waiting for 1000 mL after caesarean before treating compromise.

MSF — Early postpartum haemorrhage — obstetric manual section 8.2
· checked 2026-10-18 · verified-live
Open source ↗

4Ts assessment, atonic-PPH oxytocin, additional uterotonic choice, compression, source control, tamponade and urgent surgical escalation. WHO 2025 supplies the newer treatment-recognition trigger. Additional admission/discharge check 18 October 2026 (limited to the following): Haemorrhage resuscitat…

NICE — Intrapartum care (NG235)
2023-09-29 · updated 2026-06-09 · checked 2026-08-23 · verified-live
Open source ↗

NICE overview + Update information page (dates above confirmed)

MSF — Oxytocin injectable
· checked 2026-10-17 · verified-live
Open source ↗

PPH treatment 5–10 IU slow IV with 20 IU/L over 2 hours, total 60 IU ceiling; separate from prophylaxis and augmentation. Pump rates in the app are explicitly calculated.

Manufacturer prescribing information / DailyMed — Methylergonovine maleate injection
· checked 2026-10-17 · verified-live
Open source ↗

0.2 mg/mL, IM 0.2 mg repeat at 2–4-hour intervals, IV and hypertension precautions, and breastfeeding interruption in the label. No unsupported cumulative maximum added.

Manufacturer / emc — Ergometrine Injection BP 0.05%
· checked 2026-10-17 · verified-live
Open source ↗

200–500 micrograms IM; severe-haemorrhage slow-IV 250–500 micrograms, optional dilution to 5 mL, and vascular/hypertension contraindications. Ergometrine distinguished from methylergometrine.

Manufacturer prescribing information / DailyMed — Carboprost tromethamine injection
· checked 2026-10-17 · verified-live
Open source ↗

Refractory postpartum bleeding section: 250 micrograms/mL, 250 micrograms deep IM, 15–90-minute repeat intervals and 2 mg/eight-dose maximum; distinguished from the abortion section.

MSF — Misoprostol
· checked 2026-10-17 · verified-live
Open source ↗

800-microgram SL PPH rescue dose, tablet strengths, route-specific labour-induction intervals and oxytocin separation.

NICE — Postnatal care — NG194
· checked 2026-10-18 · verified-live
Open source ↗

Maternal/newborn transfer assessment, first void and effective feeding, handover, support/safeguarding, first midwife visit within 36 hours after transfer, postnatal danger symptoms. Full recommendations page read.

India MoHFW / NHM — District Hospital Standard Operating Procedures — LaQshya
· checked 2026-10-18 · verified-live
Open source ↗

Normal-delivery discharge not less than 48 hours: full primary SOP PDF normal-delivery/discharge passages read. Corroborated by NHM CEmONC 2024 Part 1, chapter 8. This does not define a universal post-caesarean or complicated-case stay.

WHO — WHO recommendations on quality postnatal care — official recommendation summary
· checked 2026-10-18 · verified-live
Open source ↗

Official WHO summary read: at least 24-hour facility care after birth; additional contacts at 48–72 hours, 7–14 days and week 6; individual assessment/support. Summary facts only, not a claim that the full 242-page PDF was reviewed.

WHO — Antenatal care recommendations — iron and folate doses
· checked 2026-10-17 · verified-summary
Open source ↗

Recommendation A.2.1: prevention 30–60 mg elemental iron plus 400 micrograms folic acid daily; anaemia treatment 120 mg elemental iron with 400 micrograms folic acid until Hb normal, then prevention. Limited dose-scope check through the primary WHO text indexed by NCBI; not a revalidation of every 2…

WHO / FIGO / ICM — Postpartum haemorrhage consolidated guideline — supportive postpartum iron care
· checked 2026-10-18 · verified-summary
Open source ↗

Primary recommendation table indexed at NCBI Bookshelf checked: postpartum diagnosed anaemia 120 mg elemental iron plus 400 micrograms folic acid daily until Hb normal; preventive 6–12 weeks is a separate indication. Direct table retrieval presented a browser check, so this is a limited primary-text…

RCOG — Laparoscopy — recovering well
· checked 2026-10-18 · verified-live
Open source ↗

Full primary patient recovery page read: pain control, wounds, activity/VTE, urinary/bowel and infection warning signs, adult support and no driving/important decisions during the first 24 hours after general anaesthesia. Used as general recovery/handover principles, not operation-specific discharge…

NICE — Acutely ill adults in hospital — CG50
· checked 2026-10-18 · verified-live
Open source ↗

Full primary recommendations read, focusing on critical-care-to-ward transfer: structured written handover, shared plan, monitoring, rehabilitation and receiving-team capability. Step-down is distinct from home discharge; no universal organ-support discharge cutoff is asserted.