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Postpartum hemorrhage: Medical and minimally invasive management

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

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).

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".)

INITIAL PATIENT ASSESSMENT

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).

Trends in vital signs over time after delivery should also be evaluated to identify and address patterns suspicious for ongoing bleeding or inadequately replaced blood loss. Assume progressively increasing heart rate and decreasing blood pressure are due to blood loss/hypovolemia until these causes are positively excluded. Deterioration of maternal vital signs out of proportion to vaginal bleeding suggests intraperitoneal or retroperitoneal bleeding.

                                                
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Literature review current through: Nov 2017. | This topic last updated: Dec 07, 2017.
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