Are you prepared for an OB emergency? In this special six-part podcast series, the Ohio CORES team at The Ohio State University explores the management of pregnant and postpartum women in emergency situations. Each episode focuses on a high-stakes obstetrics scenarios, including: 1) maternal morbidity and mortality, 2) postpartum hemorrhage, 3) hypertensive emergencies, 4) cardiac arrest in pregnant patients, 5) peripartum cardiomyopathy, and 6) complicated vaginal deliveries. Whether you’re in the field, ED, ICU, or on L&D, this series equips you with the knowledge to respond when seconds count. Ohio CORES (Collaborative Obstetric Resuscitation Education and Simulation) is an interdisciplinary team of educators from The Ohio State University dedicated to improving care for pregnant and postpartum women in critical condition through high-impact education and simulation training. Supported by funding from the Ohio Department of Children and Youth, Ohio CORES delivers obstetric emergency education to healthcare providers across the state. In this special episode of Crash Cart EM, we dive into postpartum hemorrhage, a leading cause of pregnancy-related deaths in Ohio and globally. We’ll discuss definitions, common causes, and clinical signs. You’ll also learn key management strategies, including assessing blood loss, fundal massage, medications, and advanced interventions like Bakri balloons and surgical options. Guests: Katie Connell, RN, BSN, C-EFM, CLC; Nicole McGarity, MHI, BSN, RN, CENHost: Jennifer Mitzman, MDEditors: Cynthia Shellhaas, MD, MPH; Kim Bambach, MD 1. Definition & Timing PPH is defined as blood loss greater than 1000 mL after vaginal or cesarean delivery. It can occur immediately or be delayed up to 12 weeks postpartum. 2. Causes: The 4 T’s Tone (uterine atony, the most common cause) Tissue (retained placenta or products of conception) Trauma (lacerations) Thrombin (coagulopathies) 3. Recognition Look for signs of hypovolemia such as tachycardia, pallor, and restlessness. Vital signs may remain normal until significant blood loss has already occured. Use additional tools for assessment. 4. Estimating Blood Loss Visual estimation is unreliable. Use scales or graduated drapes. One gram of soaked material equals one mL of blood. 5. Initial Management Start with fundal massage, establish two large-bore IVs, and give uterotonics (Pitocin, Methylergonovine, Hemabate, Cytotec, TXA). Know contraindications such as avoiding Methylergonovine in hypertension and Hemabate in asthma. 6. Escalation Use uterine tamponade devices like the Bakri balloon or Jada device. If not available, consider Foley catheters or gauze packing. Prepare early for surgery or transfer if bleeding continues. 7. Special Considerations Always ask about recent pregnancy or delivery in reproductive-age patients with unexplained bleeding. Early recognition and prompt action are critical. Resources: Virtual Obstetric Emergency Simulation Training at The Ohio State University
