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Postpartum Hemorrhage

Postpartum hemorrhage (PPH) is a serious, but rare condition, which can occur at any point up to 12 weeks postpartum. PPH is when a woman experiences excessive bleeding, more than 1000 cc or 4 cups of blood. For women and their families, understanding the risks and signs of postpartum hemorrhage is the first step in getting prompt treatment.

WATERTOWN, N.Y. – Nurses from the Samaritan Medical Center in downtown Watertown, N.Y. deliver a simulated medical baby during an emergency preparedness training scenario June 7. The training scenario had health care professionals from both Samaritan and Fort Drum, N.Y. working together to hone their skills in the event of a medical emergency. (Photo by Warren W. Wright Jr., Fort Drum MEDDAC Public Affairs)The Military Health System (MHS) is standardizing across the world, a program to identify mothers at risk, in order to deliver prompt treatment by ensuring supplies, medications, and equipment are available at every military treatment facility (MTF) that delivers babies. This program, the Postpartum Hemorrhage Bundle, uses components of national initiatives to decrease the rising complication rates for mothers during delivery and postpartum periods. The PPH bundle implementation has shown that standardization can improve outcomes for mothers and families.

The Defense Health Agency (DHA) with oversight of all the MTFs established guidelines or what is known as DHA Procedural Instruction (DHA-PI) 6025.35 with specific requirements for equipment, supplies, processes, and education.

Clinician Information & Access to Resources

From left, Lt. Christine Johnson, Lt. Cmdr. Rozalyn Love, Lt. Suzanne Papadakos, and Lt. Jessica Dalrymple, review procedures following postpartum hemorrhage training at U.S. Naval Hospital Guam. The training is meant to prepare physicians, nurses, and Corpsmen for postpartum hemorrhage events by teaching how to quantatively measure blood loss. Globally, postpartum hemorraging is the leading cause of death during pregnancy. Quantative measurements create a more accurate portrayal of how serious the bleeding is, which leads to faster and more appropriate treatment. (U.S. Navy photo by USNH Guam Public Affairs/Released)The PPH bundle is based on the Alliance for Innovation on Maternal Health (AIM) to focus on the “4 Rs” of System-level Readiness, Recognition, Response, and Reporting. This standardization provides each MTF, and clinical team with consistent resources, education, and training to optimize response and decrease adverse outcomes of PPH.

The PPH bundle follows AIM’s guidance and contains standardized processes and procedures to enhance readiness and quality of care, established through eight component areas:

  • Stage-based checklist
  • Risk assessment
  • Quantitative blood loss
  • Massive transfusion protocol
  • Obstetric emergency cart
  • Postpartum oxytocin
  • Education and training
  • Simulation and drills

The following clinician resources are currently available to help MTFs implement PPH DHA-PI 6025.35 guidance:

  • Standardized training slides on each PPH bundle component
  • Evidence-informed journal articles and resources
  • Drafts of MTF-specific protocol
  • Patient education materials

PPH is one of the top causes of maternal morbidity and mortality worldwide. Prevention of PPH is not always possible, but clinical evidence shows that prompt assessment, recognition, and timely interventions improve outcomes.

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DHA-PI 6025.35 provides guidance for implementation of a postpartum hemorrhage bundle at all MTFs providing obstetrical care.

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Guidance for Implementation of the Postpartum Hemorrhage Bundle


This Defense Health Agency-Procedural Instruction (DHA-PI), based on the authority of References (a) and (b), and in accordance with the guidance of References (c) through (n), establishes the Defense Health Agency’s (DHA) procedures for military medical treatment facilities (MTFs) providing obstetrical (OB) care to implement standardized PPHB practices. Note, the use of the name or mark of any specific manufacturer, commercial product, commodity, or service in this publication does not imply endorsement by the Department of Defense (DoD).

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