Postpartum hemorrhage is common and can occur in patients without risk factors for hemorrhage. Active management of the third stage of labor ...Advertisement<< PreviousarticleNextarticle >>Apr1,2017Issue  PostpartumHemorrhage:PreventionandTreatment Thisisanupdatedversionofthearticlethatappearedinprint.ANNEVENSEN,MD,UniversityofWisconsinSchoolofMedicineandPublicHealth,Madison,WisconsinJANICEM.ANDERSON,MD,ForbesFamilyMedicineResidencyProgram,Pittsburgh,PennsylvaniaPATRICIAFONTAINE,MD,MS,HealthPartnersInstituteforEducationandResearch,Bloomington,MinnesotaAmFamPhysician. 2017 Apr 1;95(7):442-449.ThisclinicalcontentconformstoAAFPcriteriaforcontinuingmedicaleducation(CME).SeetheCMEQuizQuestions.Authordisclosure:Norelevantfinancialaffiliations.AbstractPreventionDiagnosisandManagementOngoingorSevereHemorrhageSystemsApproachtoPreventionandTreatmentReferencesArticleSectionsAbstractPreventionDiagnosisandManagementOngoingorSevereHemorrhageSystemsApproachtoPreventionandTreatmentReferencesPostpartumhemorrhageiscommonandcanoccurinpatientswithoutriskfactorsforhemorrhage.Activemanagementofthethirdstageoflaborshouldbeusedroutinelytoreduceitsincidence.Useofoxytocinafterdeliveryoftheanteriorshoulderisthemostimportantandeffectivecomponentofthispractice.Oxytocinismoreeffectivethanmisoprostolforpreventionandtreatmentofuterineatonyandhasfeweradverseeffects.Routineepisiotomyshouldbeavoidedtodecreasebloodlossandtheriskofanallaceration.Appropriatemanagementofpostpartumhemorrhagerequirespromptdiagnosisandtreatment.TheFourT'smnemoniccanbeusedtoidentifyandaddressthefourmostcommoncausesofpostpartumhemorrhage(uterineatony[Tone];laceration,hematoma,inversion,rupture[Trauma];retainedtissueorinvasiveplacenta[Tissue];andcoagulopathy[Thrombin]).Rapidteam-basedcareminimizesmorbidityandmortalityassociatedwithpostpartumhemorrhage,regardlessofcause.Massivetransfusionprotocolsallowforrapidandappropriateresponsetohemorrhagesexceeding1,500mLofbloodloss.TheNationalPartnershipforMaternalSafetyhasdevelopedanobst