What are the limitations of the pph protocol figo?

While the pph protocol figo is highly validated, it should not replace clinical judgment. OpiCalc provides the latest evidence-based limitations for the pph protocol figo to ensure safe bedside use and optimal diagnostic accuracy.

How does the pph protocol figo compare to other Obstetrics scores?

The pph protocol figo is a gold-standard diagnostic tool. OpiCalc provides side-by-side clinical guidance to help clinicians choose the most specific evidence-based tool for their patient's presentation.

Is the pph protocol figo free to use?

Yes. OpiCalc provides the pph protocol figo completely ad-free and optimized for mobile bedside use, ensuring you can calculate medical risk swiftly and without distraction.

PPH Protocol (FIGO)

Obstetric Shock Index

Heart Rate (bpm)

Systolic BP (mmHg)

Visual EBL Reference

Full Kidney Dish≈ 500mL

10x10cm Swab (Soaked)≈ 60mL

Large Inco-pad (Soaked)≈ 250mL

Sanitary Towel (Soaked)≈ 100mL

FIGO PPH Protocol (Updated)

Universal Emergency Response Framework

Immediate Actions

Help • Oxygen • 2x LBIV
Tone/Tissue/Trauma/Thrombin
Bimanual Compression

Pharmacotherapy

OXTY 40 IU INFUSION
TXA 1g IV (Within 3h)

Refractory Care

Uterine Balloon (UBT) • NASG Garment • Surgery. If Shock Index persists > 1.1 → ACTIVATE MTP.

EVIDENCE SYNTHESIS

Clinical Reference Hub

Curated insights • How it Works • Practical Pearls • Evidence Base

CLINICAL INSIGHT

When to Use

Definition & Recognition

Cumulative blood loss ≥1,000 mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process (includes intrapartum loss) regardless of route of delivery.

When to Activate Protocol

Cumulative blood loss >500 mL in vaginal delivery or >1000 mL in Cesarean (Stage 1).
Vital sign instability (HR >110, BP <85/45, O2 sat <95%).
Visible brisk bleeding or boggy uterus unresponsive to initial massage.
Patient symptomatic of hypovolemia (lightheadedness, tachycardia, pallor).

Risk Factors

Tone: Polyhydramnios, macrosomia, multiple gestation, chorioamnionitis.
Tissue: Retained placenta, placenta accreta spectrum.
Trauma: Episiotomy, lacerations, uterine inversion/rupture.
Thrombin: Abruption, preeclampsia, known coagulopathy.

CLINICAL INSIGHT

How it Works

The 4 T’s of PPH

Tone (Atony)

Tissue (Retained products)

Trauma (Lacerations/Inversion)

Thrombin (Coagulopathy)

First-Line Uterotonics

Oxytocin (Pitocin)

Methylergonovine (Methergine)

15-methyl PGF2α (Hemabate)

Misoprostol (Cytotec)

Tranexamic Acid (TXA)

CLINICAL INSIGHT

Practical Pearls

Quantified Blood Loss (QBL) is superior to visual estimation (EBL), which typically underestimates loss by 30-50%.
Empty the bladder early; a full bladder displaces the uterus and inhibits effective contraction.
Bimanual massage must be maintained continuously while medications are being prepared.
TXA should be administered early in Stage 2 (within 3 hours of birth) as per the WOMAN trial data.

Critical Contraindications

Methergine is absolutely contraindicated in hypertensive disorders (Preeclampsia, Chronic HTN). Hemabate (Carboprost) is contraindicated in patients with reactive airway disease/asthma.

CLINICAL INSIGHT

Next Steps

Stage 1: Recognition & Initial Management

Quantify blood loss and increase IV fluids.
Fundal massage and verify bladder is empty.
Administer Oxytocin; consider Methergine if no HTN.
Type and Screen 2 units RBCs.

Stage 2: Refractory PPH (Blood Loss <1500 mL)

Mobilize PPH team (OB, Anesthesia, Nursing).
Administer 2nd/3rd line uterotonics (Hemabate, Misoprostol, TXA).
Escalate to bedside ultrasound to rule out retained products.
Prepare for intrauterine balloon tamponade (e.g., Bakri).

Stage 3: Massive Hemorrhage (>1500 mL or Instability)

Activate Massive Transfusion Protocol (MTP).
Move to Operating Room for surgical intervention.
Surgical options: B-Lynch suture, uterine artery ligation, or Hysterectomy.

CLINICAL INSIGHT

Evidence Base

Core Guidelines

Practice Bulletin No. 183: Postpartum Hemorrhage.

ACOGObstetrics & Gynecology2017

The WOMAN Trial

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage.

WOMAN Trial CollaboratorsThe Lancet2017

AWHONN Safety Bundle

The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) emphasizes that standardized unit protocols and drills significantly reduce maternal morbidity.

CLINICAL INSIGHT

Background

Development of Modern Protocols

Postpartum hemorrhage remains the leading cause of maternal mortality worldwide. Modern "Stage-Based" protocols were developed to replace the chaotic "reflexive" management of the past with a structured, multidisciplinary approach similar to ACLS.

The CMQCC Influence

The California Maternal Quality Care Collaborative (CMQCC) was instrumental in developing the toolkits that pioneered the use of QBL (Quantified Blood Loss) and standardized PPH carts, which are now global standards.

PPH Protocol (FIGO)

Obstetric Shock Index

Heart Rate (bpm)

Systolic BP (mmHg)

Visual EBL Reference

Full Kidney Dish≈ 500mL

10x10cm Swab (Soaked)≈ 60mL

Large Inco-pad (Soaked)≈ 250mL

Sanitary Towel (Soaked)≈ 100mL

FIGO PPH Protocol (Updated)

Universal Emergency Response Framework

Immediate Actions

Help • Oxygen • 2x LBIV
Tone/Tissue/Trauma/Thrombin
Bimanual Compression

Pharmacotherapy

OXTY 40 IU INFUSION
TXA 1g IV (Within 3h)

Refractory Care

Uterine Balloon (UBT) • NASG Garment • Surgery. If Shock Index persists > 1.1 → ACTIVATE MTP.

EVIDENCE SYNTHESIS

Clinical Reference Hub

Curated insights • How it Works • Practical Pearls • Evidence Base

CLINICAL INSIGHT

When to Use

Definition & Recognition

Cumulative blood loss ≥1,000 mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process (includes intrapartum loss) regardless of route of delivery.

When to Activate Protocol

Cumulative blood loss >500 mL in vaginal delivery or >1000 mL in Cesarean (Stage 1).
Vital sign instability (HR >110, BP <85/45, O2 sat <95%).
Visible brisk bleeding or boggy uterus unresponsive to initial massage.
Patient symptomatic of hypovolemia (lightheadedness, tachycardia, pallor).

Risk Factors

Tone: Polyhydramnios, macrosomia, multiple gestation, chorioamnionitis.
Tissue: Retained placenta, placenta accreta spectrum.
Trauma: Episiotomy, lacerations, uterine inversion/rupture.
Thrombin: Abruption, preeclampsia, known coagulopathy.

CLINICAL INSIGHT

How it Works

The 4 T’s of PPH

Tone (Atony)

Tissue (Retained products)

Trauma (Lacerations/Inversion)

Thrombin (Coagulopathy)

First-Line Uterotonics

Oxytocin (Pitocin)

Methylergonovine (Methergine)

15-methyl PGF2α (Hemabate)

Misoprostol (Cytotec)

Tranexamic Acid (TXA)

CLINICAL INSIGHT

Practical Pearls

Quantified Blood Loss (QBL) is superior to visual estimation (EBL), which typically underestimates loss by 30-50%.
Empty the bladder early; a full bladder displaces the uterus and inhibits effective contraction.
Bimanual massage must be maintained continuously while medications are being prepared.
TXA should be administered early in Stage 2 (within 3 hours of birth) as per the WOMAN trial data.

Critical Contraindications

Methergine is absolutely contraindicated in hypertensive disorders (Preeclampsia, Chronic HTN). Hemabate (Carboprost) is contraindicated in patients with reactive airway disease/asthma.

CLINICAL INSIGHT

Next Steps

Stage 1: Recognition & Initial Management

Quantify blood loss and increase IV fluids.
Fundal massage and verify bladder is empty.
Administer Oxytocin; consider Methergine if no HTN.
Type and Screen 2 units RBCs.

Stage 2: Refractory PPH (Blood Loss <1500 mL)

Mobilize PPH team (OB, Anesthesia, Nursing).
Administer 2nd/3rd line uterotonics (Hemabate, Misoprostol, TXA).
Escalate to bedside ultrasound to rule out retained products.
Prepare for intrauterine balloon tamponade (e.g., Bakri).

Stage 3: Massive Hemorrhage (>1500 mL or Instability)

Activate Massive Transfusion Protocol (MTP).
Move to Operating Room for surgical intervention.
Surgical options: B-Lynch suture, uterine artery ligation, or Hysterectomy.

CLINICAL INSIGHT

Evidence Base

Core Guidelines

Practice Bulletin No. 183: Postpartum Hemorrhage.

ACOGObstetrics & Gynecology2017

The WOMAN Trial

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage.

WOMAN Trial CollaboratorsThe Lancet2017

AWHONN Safety Bundle

The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) emphasizes that standardized unit protocols and drills significantly reduce maternal morbidity.

CLINICAL INSIGHT