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Overview of postpartum hemorrhage

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

INTRODUCTION

Postpartum hemorrhage (PPH) is an obstetric emergency. It is one of the top five causes of maternal mortality in both high and low per capita income countries, although the absolute risk of death from PPH is much lower in high-income countries. Timely diagnosis, appropriate resources, and appropriate management are critical for preventing death.

This topic will present an overview of major issues relating to PPH. Clinical use of specific medical and minimally invasive interventions, and surgical interventions at laparotomy, for management of PPH are discussed separately (See "Postpartum hemorrhage: Medical and minimally invasive management" and "Postpartum hemorrhage: Management approaches requiring laparotomy".)

TERMINOLOGY

PPH occurring in the first 24 hours after delivery is occasionally called primary or early PPH, and is the subject of this topic. PPH occurring from 24 hours to 12 weeks after delivery is usually called secondary, late, or delayed PPH, and is discussed separately. (See "Secondary (late) postpartum hemorrhage".)

INCIDENCE

The incidence of PPH varies widely, depending upon the criteria used to diagnose the disorder. A reasonable estimate is 1 to 5 percent of deliveries [1,2]. In an analysis of population-based data from the United States National Inpatient Sample, the incidence was between 2 and 3 percent during the years 1994 to 2006 [3].

PHYSIOLOGIC MECHANISMS THAT LIMIT POSTPARTUM BLOOD LOSS

The potential for massive hemorrhage after delivery is high because, in late pregnancy, uterine artery blood flow is 500 to 700 mL/min and accounts for approximately 15 percent of cardiac output. Normally, hemostasis occurs upon placental separation because uterine bleeding is controlled by a combination of two mechanisms:

                                      

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Literature review current through: Jul 2017. | This topic last updated: Jun 23, 2017.
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