Modern Approaches to Obstetric Haemorrhage

Abstract

Postpartum haemorrhage (PPH) is a major cause of maternal morbidity and mortality worldwide, with an increasing trend in incidence over time also in developed countries. This applies particularly to small hospitals where management protocols may not be appropriate and drugs, equipment or surgical expertise may not be on hand to deal with unexpected severe PPH. The main causes of PPH are uterine atony, retained placenta or placental fragments, and injury of soft tissue. Primary coagulation defects only rarely cause PPH. The focus of this review is on early interventions to restrict the amount of blood loss, i.e. effective use of uterotonic agents, surgical and medical interventions to remove retained placenta or placental fragments, use of balloon tamponade, early use of antifibrinolytics, replacement of low fibrinogen level, avoidance of hydroxyethyl-starch containing solutions, and the administration of red blood cells and platelets to optimise the coagulation.