What is the first-line management of postpartum hemorrhage (PPH)?

The first-line management of postpartum hemorrhage (PPH) focuses on addressing the primary reasons for the bleeding, with uterine atony being the leading cause. This is where bimanual uterine compression comes into play as an effective initial intervention.

Bimanual uterine compression involves the practitioner using both hands to apply pressure to the uterine fundus from the abdomen while simultaneously compressing the vagina. This technique helps stimulate uterine contractions, encourages the uterus to return to its normal tone, and minimizes blood loss. It is particularly useful in cases where the uterus is not contracting effectively, which is often the underlying cause of PPH.

In contrast, while intravenous fluids are essential in the overall management of PPH, they serve primarily to maintain hemodynamic stability rather than address the root cause of bleeding. Uterine massage is another supportive measure but is typically secondary to direct intervention methods like bimanual compression. Immediate hysterectomy is reserved for life-threatening situations where other measures have failed, making it a last resort rather than a first-line management strategy.

Thus, bimanual uterine compression is recognized as the most immediate and effective approach in managing postpartum hemorrhage, especially due to its direct involvement in addressing uterine atony effectively