Advertisement<< PreviousarticleNextarticle >>Mar15,2007Issue  PreventionandManagementofPostpartumHemorrhage Amorerecentarticleonpostpartumhemorrhageisavailable.JANICEM.ANDERSON,M.D.,ForbesFamilyMedicineResidencyProgram,WesternPennsylvaniaHospitalForbesRegionalCampus,Monroeville,PennsylvaniaDUNCANETCHES,M.D.,M.CL.SC.,UniversityofBritishColumbiaFacultyofMedicine,Vancouver,BritishColumbiaAmFamPhysician. 2007 Mar 15;75(6):875-882.AbstractPreventionDiagnosisandManagementClinicalApproachReferencesArticleSectionsAbstractPreventionDiagnosisandManagementClinicalApproachReferencesPostpartumhemorrhage,thelossofmorethan500mLofbloodafterdelivery,occursinupto18percentofbirthsandisthemostcommonmaternalmorbidityindevelopedcountries.Althoughriskfactorsandpreventivestrategiesareclearlydocumented,notallcasesareexpectedoravoidable.Uterineatonyisresponsibleformostcasesandcanbemanagedwithuterinemassageinconjunctionwithoxytocin,prostaglandins,andergotalkaloids.Retainedplacentaisalesscommoncauseandrequiresexaminationoftheplacenta,explorationoftheuterinecavity,andmanualremovalofretainedtissue.Rarely,aninvasiveplacentacausespostpartumhemorrhageandmayrequiresurgicalmanagement.Traumaticcausesincludelacerations,uterinerupture,anduterineinversion.Coagulopathiesrequireclottingfactorreplacementfortheidentifieddeficiency.Earlyrecognition,systematicevaluationandtreatment,andpromptfluidresuscitationminimizethepotentiallyseriousoutcomesassociatedwithpostpartumhemorrhage.Postpartumhemorrhage,definedasthelossofmorethan500mLofbloodafterdelivery,occursinupto18percentofbirths.1,2Bloodlossexceeding1,000mLisconsideredphysiologicallysignificantandcanresultinhemodynamicinstability.3Evenwithappropriatemanagement,approximately3percentofvaginaldeliverieswillresultinseverepost-partumhemorrhage.4Itisthemostcommonmaternalmorbidityindevelopedcountriesandamajorcauseofdeathworldwide.1,3Complicationsfrompostpartumhemorrhageincludeorthostatichypotension,anemia,andfatigue,whichmaymakematernalcareofthenewbornmoredifficult.