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Management of postpartum hemorrhage at cesarean delivery

Author
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

INTRODUCTION

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 (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: May 2015. | This topic last updated: Jun 26, 2015.
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