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Postpartum hemorrhage: Medical and minimally invasive management

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


Postpartum hemorrhage (PPH) is an obstetric emergency with many potentially effective interventions for management (table 1). The key to management is to recognize excessive bleeding before it becomes life threatening, identify the cause, and initiate appropriate intervention based on the clinical setting (eg, cause and severity of bleeding, whether the abdomen is open or not).

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 algorithms are two examples: (algorithm 1) and (algorithm 2); a toolkit including updated tables and algorithms is available at no cost from the California Maternal Quality Care Collaborative.

This topic will discuss medical and minimally invasive management of patients with PPH. An overview of issues related to PPH (terminology, incidence, pathogenesis, causes, risk factors, diagnosis, general principles of planning and management, morbidity and mortality, recurrence) is available separately (see "Overview of postpartum hemorrhage"). Treatment approaches to PPH that are performed at laparotomy are also reviewed separately. (See "Postpartum hemorrhage: Management approaches requiring laparotomy".)


Postvaginal delivery — Patients with persistent excessive vaginal bleeding after vaginal delivery should be assessed immediately by a provider who can initiate all necessary emergency care. Assessment includes:

Vital signs – Evaluate blood pressure, heart rate, respiratory rate, peripheral oxygen saturation, and urine output. Tachypnea, tachycardia, hypotension, low oxygen saturation, and air hunger are signs of hypovolemia, which may be due to both inadequate hemoglobin level and circulatory volume (table 2).


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Literature review current through: Jul 2017. | This topic last updated: Jun 29, 2017.
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