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Management of postpartum hemorrhage at vaginal delivery

Author
Michael A Belfort, MBBCH, MD, PhD, FRCSC, FRCOG
Section Editors
Charles J Lockwood, MD, MHCM
Steven Kleinman, 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. Avoidance of laparotomy, when possible, is a goal in patients who have had a vaginal birth, whereas this is not a major consideration at cesarean delivery. Regardless of the method of delivery, many potentially effective interventions are available for management of PPH (table 1).

This topic will discuss the approach to the patient with hemorrhage associated with vaginal delivery. As with hemorrhage after cesarean delivery, the key to management is to recognize excessive bleeding before it becomes life threatening, identify the cause, and initiate appropriate intervention. 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 table (table 2) and algorithms are examples of such protocols (algorithm 1 and algorithm 2); a toolkit including updated tables and algorithms is available at no cost from the California Maternal Quality Care Collaborative.

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 cesarean delivery is also reviewed separately:

                                     

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Literature review current through: Nov 2016. | This topic last updated: Thu Oct 13 00:00:00 GMT+00:00 2016.
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