Anesth Pain Med.  2013 Oct;8(4):209-215.

Diagnosis and management of postpartum hemorrhage

• Park SW

Abstract

Postpartum hemorrhage (PPH) is an important cause of maternal mortality. There is currently no single, satisfactory definition of PPH. The various definitions of PPH may result in delayed diagnosis. Underestimated blood loss concerning PPH is considered one of the biggest problems. The diagnosis of PPH should include proper estimation of blood loss before vital signs and clinical symptoms change. Management of PPH involves early recognition, assessment and resuscitation. Careful monitoring of vital signs, laboratory tests, coagulation testing in particular, and timely diagnosis of the cause of PPH are important. The first priority in the management of PPH is the rapid correction of hypovolemia with fluid infusion and packed red blood cells transfusion, followed by blood component therapy as indicated by the hematocrit, coagulation tests, platelet count and clinical features. Pharmacological management of PPH is to contract uterus (e.g., oxytocin, methylergonovine, 15-methylprostaglandin F2alpha, misoprostol) and to aid hemostasis (e.g., tranexamic acid, recombinant factor VIIa). Surgical management (e.g., balloon tamponade, uterine compression suture, iliac artery ligation) should be considered if hemorrhage persists or vital signs is unstable.

Keyword

Blood transfusion; Postpartum hemorrhage; Uterotonics

MeSH Terms

Blood Transfusion
Carboprost
Delayed Diagnosis
Diagnosis*
Erythrocytes
Hematocrit
Hemorrhage
Hemostasis
Hypovolemia
Iliac Artery
Maternal Mortality
Methylergonovine
Oxytocin
Platelet Count
Postpartum Hemorrhage*
Postpartum Period*
Resuscitation
Sutures
Tranexamic Acid
Uterine Balloon Tamponade
Uterus
Vital Signs
Carboprost
Methylergonovine
Oxytocin
Tranexamic Acid