Postpartum hemorrhage

Definition

• Blood loss >500mL within 24h after delivery

Epidemiology

• The leading cause of maternal mortality in developing countries, accounting for 25% of all maternal mortality worldwide

Etiology

• Uterine atony
• Retained placental tissue
• Trauma
• Bleeding diathesis

Investigations

• Antenatal CBC

Management

• Prevention
  • First-line
    • Oxytocin 10 IU IM/IV once, during third stage of labour
    • Monitor uterine tone
  • Alternative: misoprostol 600mcg PO once, during third stage of labour
  • Alternative: uterine massage
  • Adjunct: continuous cord traction, only if skilled birth attendant
• Treatment
  • First-line
    • Oxytocin
    • Uterine massage
    • Fluid resuscitation with isotonic crystalloids
  • Adjunct (if first-line fails)
    • Tranexemic acid
    • Intrauterine balloon tamponade
  • Temporizing measures
    • Bimanual uterine tamponade
    • External aortic compression
    • Non-pneumatic antishock garments
  • Last line
    • Surgical intervention
• Blood transfusion, if necessary