The prevention and treatment of postpartum haemorrhage: what do we know, and where do we go to next?

Abstract

Postpartum haemorrhage (PPH) remains a major cause of maternal deaths worldwide, and is estimated to cause the death of a woman every 10 minutes. This review presents the latest clinical advice, including new evidence on controlled cord traction, misoprostol, and oxytocin. The controversy around the diagnosis of PPH, the limitations of universal prophylaxis, and novel ways to provide obstetric first aid are also presented. It ends with a call to develop high-quality front-line obstetric services that can deal rapidly with unexpected haemorrhages as well as minimising blood loss at critical times: major abruption, placenta praevia, and caesarean for prolonged labour.

Peripartum Hysterectomy

“…Severe post partum haemorrhage remains a significant cause of maternal morbidity and mortality in both developed and developing countries [28,29]. The rate of postpartum haemorrhage requiring blood transfusion was reported to occur in 1.7% deliveries [30].…”

Nesa Days 2015, Conference Report

“…percent and new tools for treatment of the condition are available, which have to be implemented in every obstetric unit [71]. The fundamentals of action require that adequate instrumental and human capacity be provided early enough.…”

“…Especially at risk for PPH are patients presenting with placenta previa combined with a history of previous cesarean section (25 % after 1 c.s., 50 % after 2 c.s.). First line therapy of PPH requires (1) general actions, (2) stabilization of circulation and coagulation, and (3) tonisation in case of intact uterus or immediate laparotomy and suture in case of uterine rupture [70][71][72]. Second line therapy includes balloon tamponade, and surgery performed by the most skilled person available [73].…”

Efficacy and safety of blood transfusion in obstetric patients: systematic review of the literature

“…Transfusion of blood products is associated with extremely severe maternal morbidity and at least 26% of deaths secondary to postpartum haemorrhage are due to absence of blood transfusion [2]. The goal of transfusion is to increase patient survival while seeking the diagnosis and/or therapy to become effective.…”