Management of Postpartum Hemorrhage

Abstract

Postpartum Hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality both in the United States and world-wide.  To ensure prompt treatment, it is crucial to have a clear understanding of the causes of the PPH.  Treatment includes both medical and surgical approaches, with the necessary escalation of care with ongoing hemorrhage. Invasive placentation (placenta accreta, increta, percreta) has become a more common cause of hemorrhage related morbidity and mortality.  Patients with invasive placentation should be managed in a multidisciplinary fashion at a center familiar with this pathology and capable of managing massive hemorrhage.  Obstetrical units should have a PPH protocol as a tool to assist in early recognition and treatment.  Similarly, units should have a massive transfusion protocol at the ready for scenarios of ongoing obstetrical hemorrhage.  This review contains 5 figures, 4 tables and 65 references Keywords: Postpartum Hemorrhage, Obstetrical Hemorrhage, Uterine Atony, Uterine Inversion, Uterine Tamponade Balloon, Invasive Placentation, Placenta Accreta, Obstetric Hemorrhage Protocol, Massive Transfusion Protocol