Generous estimation of blood loss
Pregnancy induced cardiovascular changes protect against the effects of haemorrhage.
By term
- Cardiac output has increased by 50%
- Blood volume from 70mL/kg to 100mL/kg (5 to 7 litres/kg)
Tachycardia may be the only sign of haemorrhage until 30 to 40% of the circulating volume has been lost.
Complete PPH risk assessment score with management pathway chart for ALL women at booking of elective section, admission in labour, for IOL or augmentation of labour. Complete prior to second stage and following delivery
Commence National MEWS chart
Table 1: Clinical features of shock in pregnancy related to blood loss
Blood loss |
Clinical features |
Level of shock |
500mL to 1000mL |
Normal blood pressure Tachycardia Palpitations , dizziness
Stage 0: 15% blood loss or less |
Compensated |
1000mL to 1500mL |
Hypotension systolic 90 to 80mmHg Tachycardia Tachypnoea (21 to 30 breaths/min) Delayed capillary refill time Pallor, sweating Weakness, faintness, thirst
Stage 1: 15 to 30% blood loss |
Mild |
1500mL or more |
Hypotension 80 to 60mmHg Rapid, weak pulse greater than 110bpm Tachypnoea greater than 30 Pallor, cold clammy skin Poor urinary output less than 30mL/hr Restless, anxiety , confusion |
Moderate |
2000mL or more |
Severe hypotension less than 50mmHg Pallor, cold clammy skin, peripheral cyanosis Air hunger Anuria, confusion or unconsciousness, collapse
Stage 3: 30% blood loss or higher and ongoing clinical concerns |
Severe |
Maternity & Child Quality Improvement Collaborative (SPSP)
Recommends quantitative assessment of blood loss.
All women who deliver, regardless of method of delivery, should be assessed for blood loss. More accurate methods, such as graduated drapes and weighing of pads, should be used for women with an estimated blood loss of a 1,000mL and above.