Postpartum hemorrhage

Postpartum hemorrhage is defined as excessive blood loss following delivery of the fetus. Bleeding might occur before, during or after the delivery of the placenta. As the consequence of inereased blood volume in pregnaney and that of the hemodynamic changes occurring postpartum most patients can tolerate blood losses up to 1500 mI., provided that they are in good health and were not anemic before pregnancy. The diagnosis of postpartum hemorrhage is usually imprecise because for the wide range of blood loss following delivery encountered normally and the inaccuracy of the estimation of the amount of lost blood. The incidence of postpartum hemorrhage is approximately 5-10 % after vaginal delivery.
Postpartum hemorrhage is one of the leading causes of maternal mortality worldwide. Major causes of early postpartum hemorrhage are uterine atony, obstetric trauma, retained placental tissue, uterine inversion and coagulation defects. Causes of delayed postpartum bleeding include: uterine subinvolution, retained placental tissue, endometritis or placental polyp. As caesarean section rate increases in the well-developed areas of the world. dehiscence of the previous uterine scar may be an increasing cause of poslpartum bleeding.
When the risk factors ol postpartum hemorrhage are suspected or present, preventive measures should be instituted. Correction of anemia before delivery is a basic preventive measure to be instituted. Blood should be readily available in risk patients, like those with known placenta previa. Predelivery replacement of coagulation factors in patients with bleeding disorders should be managed. Prophylactic and proper use of oxytocic agents during and especially after delivery might decrease the risk of atony in the postpartum period.
Two basic principles govern the treatment of postpartum hemorrhage: the bleeding must be arrested and the blood volume must be restored as soon as possible. Successful management with a favorable outcome can be achieved only by correct identification of the cause of the bleeding and a very rapid decision-making at the same time. Wasting time might result in maternal death. Decrease in mortality rates can only be achieved in place.s where all the vital criteria of controlling serious postpartum hemorrhage meet, and a real teamwork is established.