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Management of postpartum hemorrhage at cesarean delivery

Michael A Belfort, MBBCH, MD, PhD, FRCSC, FRCOG
Section Editors
Charles J Lockwood, MD, MHCM
Deborah Levine, MD
Deputy Editor
Vanessa A Barss, MD, FACOG


The approach to treatment of postpartum hemorrhage (PPH) differs somewhat depending on the cause and whether hemorrhage occurs after a vaginal birth or after a cesarean delivery. This topic will discuss the approach to the patient with hemorrhage associated with cesarean delivery. As with hemorrhage after vaginal delivery, the key to management is to recognize excessive bleeding before it becomes life-threatening, identify the cause, and initiate appropriate interventions. Many potentially effective interventions are possible (table 1). Increasingly, hospitals have adopted policies, protocols, and guidelines to deal with massive obstetric hemorrhage. A clinician practicing obstetrics should be aware of the existence and content of such protocols; the following two algorithms are representative examples (note algorithm 1 is being revised to include tranexamic acid) (algorithm 1 and algorithm 2). In addition, numerous professional organizations have provided guidance for management of PPH; a toolkit including updated tables and algorithms is available at no cost from the California Maternal Quality Care Collaborative. (See "Overview of postpartum hemorrhage", section on 'Guidelines from professional organizations'.)

An overview of issues related to PPH: definition, incidence, pathogenesis, causes, risk factors, diagnosis, general principles of planning and management, complications, recurrence, and secondary hemorrhage, is available separately:

(See "Overview of postpartum hemorrhage".)

Management of the patient with PPH after vaginal delivery is also reviewed separately.

(See "Management of postpartum hemorrhage at vaginal delivery".)


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Literature review current through: Apr 2017. | This topic last updated: May 03, 2017.
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