Reducing the risk of postpartum haemorrhage in paramedic practice

Primary postpartum haemorrhage is the most common form of obstetric haemorrhage. Poor recognition and treatment of this condition has been linked to cases of mortality in recent years. Greater choice over birth settings for mothers and a national shortage of midwives are likely to result in more frequent exposure to maternity cases for paramedics in future years. Active management of the third stage of labour reduces the risks of primary postpartum haemorrhage and shortens the length of the third stage of labour. UK ambulance service guidelines are currently based upon physiological management of the third stage of labour, so in the absence of a midwife, paramedics cannot actively manage the third stage. Paramedic training has moved to higher education university programmes in recent years and undergraduate paramedic students receive additional training about the management of obstetric emergencies. This article discusses current clinical practice and recommends that paramedics adopt active management of the third stage of labour, in order to reduce the risk of primary postpartum haemorrhage. In addition, the author asks whether current paramedic practice is effective in treating primary postpartum haemorrhage within the pre-hospital setting, when a midwife is not present at the scene.

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