What criteria should I use to determine whether a patient with postpartum haemorrhage requires referral to secondary care?

To determine whether a patient with postpartum haemorrhage (PPH) requires referral to secondary care, the following criteria should be considered:

• Immediate Transfer to Obstetric-Led Care or Emergency Hospital Admission:
  • If a woman has a postpartum haemorrhage, transfer to obstetric-led care should be arranged ².
  • Emergency hospital admission is indicated for suspected secondary postpartum haemorrhage ¹.
  • If the placenta is retained and the woman is not already in an obstetric unit, transfer should be arranged, with urgency increasing if multiple risk factors are present ².
  • Referral directly to Accident and Emergency is necessary if the woman is haemodynamically unstable, including signs such as pallor, tachycardia, hypotension, shock, or collapse ⁵,⁶.
  • Significant concern about the degree of bleeding or pain also warrants direct referral to Accident and Emergency ⁵,⁶.
• Factors Worsening Consequences (Lowering Referral Threshold):
  • Be aware that anaemia may worsen the consequences of secondary postpartum haemorrhage ⁴.
  • A weight of less than 50 kg at the first midwife appointment during pregnancy (booking appointment) may also worsen the consequences of secondary postpartum haemorrhage ⁴.
• Antenatal Considerations:
  • Women with antenatal risk factors for PPH should be advised to give birth in an obstetric unit, where more emergency treatment options are available ².