Cover Story

Seven ways to control postpartum hemorrhage

By Ashley S. Roman, MD, MPH, and Andrei Rebarber, MD

Although you can't always anticipate a potentially catastrophic obstetric hemorrhage, rapid diagnosis and intervention can make all the difference in the world. The authors review interventions—new and old—and tell clinicians what to have on hand to implement them.

Massive uncontrolled hemorrhage after childbirth is the leading cause of pregnancy-related death in the United States and one of the most common causes of maternal death.¹ Even though infant mortality has steadily declined since 1982, thanks to modern advances in neonatal intensive care unit technology, maternal mortality in the US has not improved for two decades—holding steady at 7.7 deaths per 100,000 live births between 1982 and 1996.² Of 1,459 reported pregnancy-related deaths between 1987 and 1990, hemorrhage accounted for about three out of every 10 (29%).³ Moreover, obstetric hemorrhage can cause shock, renal failure, and Sheehan's syndrome (postpartum pituitary necrosis); if the bleeding cannot be stopped in time, hysterectomy is often necessary.

Postpartum hemorrhage (PPH) is traditionally defined as a blood loss of more than 500 mL after vaginal delivery and more than 1,000 mL after cesarean delivery, but intraoperative estimations of blood loss are notoriously inaccurate. Thus, the American College of Obstetricians and Gynecologists defines it as a decrease in hematocrit of more than 10% from before to after delivery.⁴