In cases of unresponsive postpartum hemorrhage, what is the next step after bimanual compression?

In situations of unresponsive postpartum hemorrhage, following bimanual compression, the appropriate next step is the administration of intravenous oxytocin and/or ergometrine. This is because these medications are uterotonics that stimulate uterine contraction, which is crucial in managing postpartum hemorrhage. Uterine atony, or the failure of the uterus to contract following delivery, is a common cause of excessive bleeding. By administering oxytocin or ergometrine, the aim is to promote contraction of the uterine muscles, thereby controlling the hemorrhage.

The use of IV fluids, while important for maintaining blood volume, is more of a supportive measure and does not directly address the cause of the hemorrhage as pharmacologic agents do. Immediate emergency surgery might be necessary in some cases of unresolved bleeding, but it is typically considered after pharmacological interventions have been exhausted or in the presence of specific complications such as retained products of conception. Blood transfusion, while critical in cases of significant blood loss, is generally indicated after assessing the need based on the patient's hemodynamic status and response to initial treatments. Thus, the priority lies in utilizing uterotonics to directly address the underlying issue of uterine atony.