Bimanual and aortic compression

Life-saving emergency procedures to slow bleeding ​from uterus when other procedures haven't worked

• Make sure you follow steps in Primary postpartum haemorrhage — use bimanual or aortic compression to control ongoing bleeding

Do

• Explain to woman and support people what you are doing and why it is urgent
• Continue until bleeding ​controlled or emergency help arrives

Bimanual compression

Puts pressure on uterus to slow bleeding​

• Consider pain relief
• Put on sterile gloves and cover 1 hand with lots of water-based lubricant
• Make fist with lubricated hand. Put into lower vagina, push firmly against uterus — Figure 1.55
• Other hand on external abdomen lifts and pulls uterus forward, pushing it down over fist — Figure 1.55

Aortic compression

Puts pressure on abdominal aorta to slow bleeding. Use​ when all other measures have failed

• Have helper find femoral pulse in woman's right groin
• Use bent fingers (knuckles) of dominant (main) hand
• Press down on abdomen just above and slightly to left of umbilicus (belly‑button) — Figure 1.56 
• Feel for pulsations to check you are over aorta
• When enough pressure is applied to compress aorta between your fist and woman’s spine the helper will feel femoral artery pulse disappear