Postpartum hemorrhage

Postpartum hemorrhage
Classification and external resources
ICD-10 O72
ICD-9 666

Hemorrhage after delivery, or postpartum hemorrhage, is the loss of greater than 500 ml of blood following vaginal delivery, or 1000 ml of blood following cesarean section. It is the most common cause of perinatal maternal death in the developed world and is a major cause of maternal morbidity worldwide.[1]

Contents

Causes

Causes of postpartum hemorrhage and their incidence[1]
Cause Incidence
Uterine atony 70%
Trauma 20%
Retained tissue 10%
Coagulopathy 1%

Causes of postpartum hemorrhage are uterine atony, trauma, retained placenta, and coagulopathy, commonly referred to as the "four Ts":[1]

Management

Medication

Intravenous oxytocin is the drug of choice for postpartum hemorrhage. Misoprostol may also be effective if oxytocin is not available.[2]

Protocol

A detailed stepwise management protocol has been introduced by the California Maternity Quality Care Collaborative.[3] It describes 4 stages of obstetrical hemorrhage after a delivery and its application reduces maternal mortality.[4]

A Cochrane database study[5] suggests that active management (use of uterotonic drugs, cord clamping and controlled cord traction) of the third stage of labour reduces severe maternal bleeding and anemia compared to expectant management. However, the review also found that active management reduced the baby’s birthweight and increased the mother's blood pressure, afterpains, nausea, vomiting, and use of drugs for pain relief. The number of women returning to hospital with bleeding also increased. Another Cochrane database study[6], focusing specifically on the timing of the administration of the uterotonic drug oxytocin as part of the active management of the third stage of labour, suggested that administering the drug before the expulsion of the placenta did not have any significant influence on the incidence of postpartum hemorrhage when compared to administering the drug after the expulsion of the placenta.

See also

References

  1. ^ a b c Anderson JM, Etches D (March 2007). "Prevention and management of postpartum hemorrhage". American Family Physician 75 (6): 875–82. PMID 17390600. 
  2. ^ "Treatment of post-partum haemorrhage with sublingual misoprostol versus oxytocin in women not exposed to oxytocin during labour: a double-blind, randomised, non-inferiority trial : The Lancet". http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2961924-3/abstract. 
  3. ^ [1] CMQCC guidelines, accessed August 10, 2009
  4. ^ Barbieri RL. "Planning reduces the risk of maternal death. This tool helps". OBG Management (2009) 21 (8):8-10. 
  5. ^ Prendiville WJ, Elbourne D, McDonald S. (2000). Begley, Cecily M. ed. "Active versus expectant management in the third stage of labour.". Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD000007. DOI: 10.1002/14651858.CD000007. doi:10.1002/14651858.CD000007. 
  6. ^ Soltani H, Hutchon DR, Poulose TA. (2010). Soltani, Hora. ed. "Timing of prophylactic uterotonics for the third stage of labour after vaginal birth". Cochrane Database of Systematic Reviews, Issue 8. Art. No.: CD006173. DOI: 10.1002/14651858.CD006173.pub2. doi:10.1002/14651858.CD006173.pub2. 

External links