Postpartum Hemorrhage Event Note

Event Recognition Time: [Timestamp of initial PPH recognition]

Note Time: [Timestamp of note entry]

Location: [Clinical location]

Delivery Context: [Delivery type and time; time since delivery; placental status; anesthesia type; key risk factors]

Recognition and Initial Assessment

Trigger: [Trigger for concern]

Initial Vitals: [HR, BP, SpO2, other relevant parameters at recognition]

Clinical Status: [Mental status, symptoms, perfusion indicators, shock index if available]

IV Access: [Number of lines, gauge, central access if present]

QBL at Recognition: [Cumulative mL] via [measurement method]

Etiology Assessment (4 Ts)

Tone: [Uterine tone assessment and response to massage/uterotonics]

Trauma: [Findings on evaluation for lacerations, hematoma, rupture; repairs if performed]

Tissue: [Placental completeness; ultrasound findings if performed]

Thrombin: [Coagulopathy indicators; relevant labs if available]

Working Diagnosis: [Suspected primary etiology; secondary etiologies if suspected] (Label as "suspected" unless definitively confirmed.)

Interventions

(Document each intervention with dose, route, time, and response. Time-stamp all critical actions.)

Uterotonics/Medications: [Agents given with dose, route, time, response; note TXA time relative to delivery; note contraindications if agent withheld; fluids/resuscitation details]

Procedures/Devices: [Uterine massage, balloon tamponade, surgical interventions, IR procedures as applicable with timing and response]

Transfusion: [Products given, units, timing, emergency release vs crossmatched, reactions] (Reference transfusion record for unit identifiers.)

Escalation: [Hemorrhage protocol activation time; MTP activation if applicable; OR/IR/ICU involvement; key notification times]

Critical Actions Timeline: [Chronological sequence from recognition → activation → interventions → control, with timestamps]

Clinical Course

QBL Progression: [Cumulative totals at key timepoints through hemorrhage control or current status] (Do not back-calculate from hemoglobin changes.)

Hemorrhage Status: [Controlled / ongoing]; [current uterine tone]; [lochia description]

Hemodynamic Status: [Current vitals, urine output if catheterized, perfusion status]

Complications: [DIC, hypothermia, acidosis, pressors, intubation, return to OR, or none]

Post-Event Plan

Disposition: [Location and level of care with rationale if escalated]

Monitoring: [Vital sign and fundal check frequency; ongoing QBL tracking if applicable; I/O monitoring]

Labs: [Timing for repeat CBC, coagulation studies, fibrinogen; transfusion triggers]

Medications: [Ongoing uterotonics; antibiotics if indicated; VTE prophylaxis; iron therapy considerations]

Escalation Criteria: [Specific thresholds for reactivation: HR, SBP, shock index, recurrent heavy bleeding]

Patient Communication: [Counseling provided, emotional support offered, follow-up plan]