Skip to main content
SpringerLink
Log in
Book cover

Bleeding During Pregnancy pp 179–196Cite as

Postpartum Hemorrhage

  • Chapter
  • First Online:

Abstract

Simply put, postpartum hemorrhage (PPH) is excessive bleeding after childbirth. It is a leading cause of maternal mortality worldwide, but most of the deaths occur in low-income countries. Specifically, PPH is defined as blood loss of >500 ml after vaginal delivery or >1,000 ml after cesarean delivery. “Early” PPH occurs within 24 h after delivery, and “late” PPH occurs between 24 h and 6 weeks after delivery. In most parts of the world, PPH accounts for 35–55% of maternal deaths. In rural regions and low-income countries, where access to quick medical attendance is limited, it is a major health concern. Even in industrialized countries, what may be considered a low-risk birth can rapidly deteriorate into hypovolemic shock and death through PPH. Therefore, although it is considered a treatable obstetrical emergency, delayed treatment results in significant morbidity and mortality [1].

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Mathai M, Gülmezoglu A, Hill S. WHO Department of Making Pregnancy Safer. Recommendations for the prevention of postpartum hemorrhage. 2007. WHO/MPS/07.06.

    Google Scholar 

  2. Ford J, Roberts C, Simpson J, Vaughan J, Cameron C. Increased postpartum hemorrhage rates in Australia. Int J Gynaecol Obstet. 2007;98(3):237–43.

    Article  PubMed  CAS  Google Scholar 

  3. Joseph K, Rouleau J, Kramer M, et al. Investigation of an increase in postpartum haemorrhage in Canada. BJOG. 2007;114(6):751–9.

    Article  PubMed  CAS  Google Scholar 

  4. Schutte J, Steegers E, Schuitemaker N, et al. Rise in maternal mortality in the Netherlands. BJOG. 2010;117(4):399–406.

    Article  PubMed  CAS  Google Scholar 

  5. World Health Organization. Health and the millennium development goals. Geneva: World Health Organization; 2005.

    Google Scholar 

  6. Mousa H, Alfirevic Z. Treatment for primary postpartum haemorrhage. Cochrane Database Syst Rev. 2007;(1):CD003249.

    Google Scholar 

  7. Carroli G, Cuesta C, Abalos E, Gulmezoglu A. Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol. 2008;22(6):999–1012.

    Article  PubMed  Google Scholar 

  8. Sheiner E, Ohel I, Hadar A. Out of hospital deliveries and post partum hemorrhage. In: Lynch CB, Keith L, Lalonde A, Karoshi M, editors. A textbook of post-partum hemorrhage. Dumfries, Scotland: Sapiens Publishing; 2006.

    Google Scholar 

  9. Bose P, Regan F, Paterson-Brown S. Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions. BJOG. 2006;113(8):919–24.

    Article  PubMed  CAS  Google Scholar 

  10. Maslovitz S, Barkai G, Lessing J, Ziv A, Many A. Improved accuracy of postpartum blood loss estimation as assessed by simulation. Acta Obstet Gynecol Scand. 2008;87(9):929–34.

    Article  PubMed  Google Scholar 

  11. Zhang W, Deneux-Tharaux C, Brocklehurst P, et al. Effect of a collector bag for measurement of postpartum blood loss after vaginal delivery: cluster randomised trial in 13 European countries. BMJ. 2010;340:c293.

    Article  PubMed  Google Scholar 

  12. Smith G, Prytherch D, Schmidt P, et al. Hospital-wide physiological surveillance – a new approach to the early identification and management of the sick patient. Resuscitation. 2006;71(1):19–28.

    Article  PubMed  Google Scholar 

  13. Khan K, Wojdyla D, Say L, Gülmezoglu A, Van Look P. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367(9516):1066–74.

    Article  PubMed  Google Scholar 

  14. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006: postpartum hemorrhage. Obstet Gynecol. 2006;108(4):1039–47.

    Article  Google Scholar 

  15. Hill K. Making deaths count. Bull World Health Organ. 2006;84(3):162.

    Article  PubMed  Google Scholar 

  16. Drife J. Maternal mortality in well-resourced countries: is there still a need for confidential enquiries? Best Pract Res Clin Obstet Gynaecol. 2008;22(3):501–15.

    Article  PubMed  Google Scholar 

  17. Lema V, Changole J, Kanyighe C, Malunga E. Maternal mortality at the Queen Elizabeth Central Teaching Hospital, Blantyre, Malawi. East Afr Med J. 2005;82(1):3–9.

    PubMed  CAS  Google Scholar 

  18. Soltani H. Uterine massage for preventing postpartum hemorrhage: RHL commentary. Geneva: The WHO Reproductive Health Library; last updated April 2010.

    Google Scholar 

  19. Onakewhor J, Gharoro E. Changing trends in maternal mortality in a developing country. Niger J Clin Pract. 2008;11(2):111–20.

    PubMed  CAS  Google Scholar 

  20. Lewis G. Why mothers die 2000–2002: the sixth report of the confidential enquiries into maternal deaths in the United Kingdom. London: RCOG; 2004.

    Google Scholar 

  21. Callaghan W, Kuklina E, Berg C. Trends in postpartum hemorrhage: United States, 1994–2006. Am J Obstet Gynecol. 2010;202(4):353.e1–6.

    Article  Google Scholar 

  22. Ohel I, Holcberg G, Sheiner E. Epidemiology of post-partum hemorrhage. In: Sheiner E, editor. Textbook of Perinatal Epidemiology. Nova Science Publishers; 2010.

    Google Scholar 

  23. Shechter Y, Levy A, Wiznitzer A, Zlotnik A, Sheiner E. Obstetric complications in grand and great grand multiparous women. J Matern Fetal Neonatal Med. 2010;23(10):1211–7.

    Article  PubMed  Google Scholar 

  24. Knight M, Callaghan W, Berg C, Alexander S, Bouvier-Colle M, Ford J, Joseph KS, Lewis G, Liston R, Roberts C, Oats J, and Walker J. Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy Childbirth. 2009;9(1):55.

    Google Scholar 

  25. Walker J. Confidential enquiries into maternal mortality. BJOG. 2010;117(4):379–81.

    Article  PubMed  CAS  Google Scholar 

  26. Sheiner E, Sarid L, Levy A, Seidman D, Hallak M. Obstetric risk factors and outcome of pregnancies complicated with early postpartum hemorrhage: a population-based study. J Matern Fetal Neonatal Med. 2005;18(3):149–54.

    Article  PubMed  Google Scholar 

  27. Combs C, Murphy E, Laros RJ. Factors associated with postpartum hemorrhage with vaginal birth. Obstet Gynecol. 1991;77(1):69–76.

    PubMed  CAS  Google Scholar 

  28. Bais J, Eskes M, Pel M, Bonsel G, Bleker O. Postpartum haemorrhage in nulliparous women: incidence and risk factors in low and high risk women. A Dutch population-based cohort study on standard (> or  =  500 ml) and severe (> or  =  1000 ml) postpartum haemorrhage. Eur J Obstet Gynecol Reprod Biol. 2004;115(2):166–72.

    PubMed  Google Scholar 

  29. Stones R, Paterson C, Saunders N. Risk factors for major obstetric haemorrhage. Eur J Obstet Gynecol Reprod Biol. 1993;48(1):15–8.

    Article  PubMed  CAS  Google Scholar 

  30. Ford J, Roberts C, Bell J, Algert C, Morris J. Postpartum haemorrhage occurrence and recurrence: a population-based study. Med J Aust. 2007;187(7):391–3.

    PubMed  Google Scholar 

  31. Prendiville WJ, Elbourne D, McDonald S. Active versus expectant management in the third stage of labour. Cochrane Database Syst Rev. 2000;(3):CD000007.

    Google Scholar 

  32. Althabe F, Buekens P, Bergel E, et al. A behavioral intervention to improve obstetrical care. N Engl J Med. 2008;358(18):1929–40.

    Article  PubMed  CAS  Google Scholar 

  33. Roberts I, Alderson P, Bunn F, Chinnock P, Ker K, Schierhout G. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2004;(4):CD000567.

    Google Scholar 

  34. World Health Organization DoRHaR, Department of Making Pregnancy Safer, Department of Essential Medicines and Pharmaceutical Policy. WHO Statement regarding the use of misoprostol for postpartum hemorrhage prevention and treatment. 2009.

    Google Scholar 

  35. Kundodyiwa T, Majoko F, Rusakaniko S. Misoprostol versus oxytocin in the third stage of labor. Int J Gynaecol Obstet. 2001;75(3):235–41.

    Article  PubMed  CAS  Google Scholar 

  36. Gülmezoglu A, Forna F, Villar J, Hofmeyr G. Prostaglandins for preventing postpartum haemorrhage. Cochrane Database Syst Rev. The Cochrane Library. 2007;(4):CD000494.

    Google Scholar 

  37. Alfirevic Z, Elbourne D, Pavord S, et al. Use of recombinant activated factor VII in primary postpartum hemorrhage: the Northern European registry 2000–2004. Obstet Gynecol. 2007;110(6):1270–8.

    Article  PubMed  CAS  Google Scholar 

  38. Welsh A, McLintock C, Gatt S, Somerset D, Popham P, Ogle R. Guidelines for the use of recombinant activated factor VII in massive obstetric haemorrhage. Aust N Z J Obstet Gynaecol. 2008;48(1):12–6.

    Article  PubMed  Google Scholar 

  39. Ahonen J, Jokela R, Korttila K. An open non-randomized study of recombinant activated factor VII in major postpartum haemorrhage. Acta Anaesthesiol Scand. 2007;51(7):929–36.

    Article  PubMed  CAS  Google Scholar 

  40. Sivan E, Spira M, Achiron R, et al. Prophylactic pelvic artery catheterization and embolization in women with placenta accreta: can it prevent cesarean hysterectomy? Am J Perinatol. 2010;27(6):455–61.

    Article  PubMed  Google Scholar 

  41. Elhassan E, Mirghani O, Adam I. The B-Lynch surgical technique for control of postpartum haemorrhage. J Obstet Gynaecol. 2010;30(1):94.

    Article  PubMed  CAS  Google Scholar 

  42. El-Hamamy E, Wright A, B-Lynch C. The B-Lynch suture technique for postpartum haemorrhage: a decade of experience and outcome. J Obstet Gynaecol. 2009;29(4):278–83.

    Article  PubMed  CAS  Google Scholar 

  43. Cho J, Jun H, Lee C. Hemostatic suturing technique for uterine bleeding during cesarean delivery. Obstet Gynecol. 2000;96(1):129–31.

    Article  PubMed  CAS  Google Scholar 

  44. Hayman R, Arulkumaran S, Steer P. Uterine compression sutures: surgical management of postpartum hemorrhage. Obstet Gynecol. 2002;99(3):502–6.

    Article  PubMed  CAS  Google Scholar 

  45. Sentilhes L, Descamps P, Marpeau L. Has B-Lynch suture hidden long-term effects? Fertil Steril. 2010;94(4):e62.

    Article  PubMed  Google Scholar 

  46. AbdRabbo S. Stepwise uterine devascularization: a novel technique for management of uncontrolled postpartum hemorrhage with preservation of the uterus. Am J Obstet Gynecol. 1994;171(3):694–700.

    PubMed  CAS  Google Scholar 

  47. O’Leary J. Uterine artery ligation in the control of postcesarean hemorrhage. J Reprod Med. 1995;40(3):189–93.

    PubMed  Google Scholar 

  48. Camuzcuoglu H, Toy H, Vural M, Yildiz F, Aydin H. Internal iliac artery ligation for severe postpartum hemorrhage and severe hemorrhage after postpartum hysterectomy. J Obstet Gynaecol Res. 2010;36(3):538–43.

    Article  PubMed  Google Scholar 

  49. Doumouchtsis S, Papageorghiou A, Arulkumaran S. Systematic review of conservative management of postpartum hemorrhage: what to do when medical treatment fails. Obstet Gynecol Surv. 2007;62(8):540–7.

    Article  PubMed  Google Scholar 

  50. Tsu V, Sutanto A, Vaidya K, Coffey P, Widjaya A. Oxytocin in prefilled Uniject injection devices for managing third-stage labor in Indonesia. Int J Gynaecol Obstet. 2003;83(1): 103–11.

    Article  PubMed  CAS  Google Scholar 

  51. Strand R, Da Silva F, Jangsten E, Bergström S. Postpartum hemorrhage: a prospective, comparative study in Angola using a new disposable device for oxytocin administration. Acta Obstet Gynecol Scand. 2005;84(3):260–5.

    PubMed  Google Scholar 

  52. Carroli G, Belizan J, Grant A, Gonzalez L, Campodonico L, Bergel E. Intra-umbilical vein injection and retained placenta: evidence from a collaborative large randomised controlled trial. Grupo Argentino de Estudio de Placenta Retenida. Br J Obstet Gynaecol. 1998;105(2): 179–85.

    Article  PubMed  CAS  Google Scholar 

  53. Akther S. Innovations in the treatment of PPH. Proceedings of preventing postpartum hemorrhage: from research to practice. Bangkok, Thailand; 2004.

    Google Scholar 

  54. AbouZahr C, Wardlaw T. Maternal mortality in 2000: estimates developed by WHO, UNICEF and UNFPA. Geneva: World Health Organization Department of Reproductive Health and Research; 2004.

    Google Scholar 

  55. Schneid-Kofman N, Sheiner E. Frustration from not achieving the expected reduction in maternal mortality. Arch Gynecol Obstet. 2008;277(4):283–4.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    Rachel Pope

Authors
  1. Rachel Pope
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Iris Ohel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gershon Holcberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eyal Sheiner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rachel Pope .

Editor information

Editors and Affiliations

  1. , Department of Ob/Gyn, Ben-Gurion University of the Negev, P.O. Box 151, Be'er-Sheva, 84841, Israel

    Eyal Sheiner

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Pope, R., Ohel, I., Holcberg, G., Sheiner, E. (2011). Postpartum Hemorrhage. In: Sheiner, E. (eds) Bleeding During Pregnancy. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-9810-1_11

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-9810-1_11

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-9809-5

  • Online ISBN: 978-1-4419-9810-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation