PPH Episode 1: Recognise and Prevent | Mrs. P Teaching Case (8 min)

#PostpartumHemorrhage #PPH #NursingEducation Episode 1 of 5: Mrs. P is 20 minutes after birth with 350 mL measured loss, pulse 112 and BP 98/62. What do you do, and what should have been prepared before? Follow one invented teaching case through risk assessment, prevention at birth, objective blood-loss measurement, the WHO 2025 trigger, shock index and the four causes (tone, trauma, tissue, thrombin). Designed for 4th-year undergraduate and postgraduate nursing and midwifery students, with 5 case-based MCQs and clinical reasoning. WHAT YOU WILL LEARN Why risk assessment guides preparation, not whether to monitor, and what a high-risk history changes WHO 2025 prevention: oxytocin 10 IU IM or IV preferred, and what is not recommended for routine prevention How to measure blood loss cumulatively and announce the number and the trend The first-response trigger: at least 300 mL plus an abnormal sign, or at least 500 mL; shock index above 1 Why one normal blood pressure can be falsely reassuring Tone, trauma, tissue, thrombin: assessing the four causes together CLINICAL PEARLS Do not wait for 1,000 mL: it is an outcome used in trials, not a threshold to wait for. Announce cumulative measured loss and the recent rate; never restart the count at transfer. A boggy uterus supports atony; bright bleeding with a firm uterus should speed up inspection for trauma. TEST YOURSELF Five case-based MCQs at 4:35, answers with clinical reasoning at 6:21. Pause and decide before the reveal. CHAPTERS 0:00 Meet Mrs. P (teaching case) 0:32 Risk assessment before birth 1:09 Prevention at birth 1:52 Measure the loss 2:27 Recognise: the WHO 2025 trigger 3:04 Why bleeding becomes dangerous 3:34 Four causes: tone, trauma, tissue, thrombin 4:05 Pause and reflect (Tanner) 4:35 Test yourself: 5 case MCQs 6:21 Answers with clinical reasoning 7:52 Take-home message 8:11 Key references TAKE-HOME Risk assessment guides preparation. Give one quality-assured uterotonic and document it. Measure cumulative loss and announce the trend. Act at 300 mL plus a sign, or 500 mL, without waiting for 1,000 mL. NEXT EPISODE Episode 2: the first 15 minutes of the emergency response (roles, bundle, escalation and SBAR). NOTE ON SOURCES Based on a comprehensive PPH nursing review provided by the presenter (WHO 2025, RTCOG OB 68-041, FIGO, safety bundles and primary trials). Mrs. P is an invented teaching case. Doses and checklists are educational summaries, not prescribing orders. Tanner's model is a teaching framework added by the presenter. Please verify references before formal citation. DISCLAIMER For education only. Follow your local protocol, scope of practice and authorised orders. It does not replace clinical judgement. PRESENTER Dr. Lawitra Khiaokham Faculty of Nursing, Chiang Mai University KEY REFERENCES (abbreviated) Alliance for Innovation on Maternal Health (2022). https://saferbirth.org/psbs/obstetric... California Maternal Quality Care Collaborative (2022). https://www.cmqcc.org/toolkits-qualit... Escobar et al. (2022). https://pmc.ncbi.nlm.nih.gov/articles... Gallos et al. (2023). doi:10.1056/NEJMoa2303966 National Institute for Health and Care Excellence (2023). https://www.nice.org.uk/guidance/ng23... Pacheco et al. (2023). doi:10.1056/NEJMoa2207419 Royal Thai College of Obstetricians and Gynaecologists (2025). https://www.rtcog.or.th/content/readf... Widmer et al. (2018). doi:10.1056/NEJMoa1805489 WOMAN-2 Trial Collaborators (2024). doi:10.1016/S0140-6736(24)01749-5 World Health Organization, International Federation of Gynecology and Obstetrics, & International Confederation of Midwives (2025). https://www.who.int/publications/i/it... #PostpartumHemorrhage #PPH #NursingEducation #Midwifery #ObstetricEmergency #ClinicalJudgment #TannerModel #NursingStudents #MaternalHealth #EvidenceBasedPractice #QuantitativeBloodLoss #ShockIndex #WHOGuideline #DoodleLearning #MidwiferyStudents