Obstetrical Management of Postpartum Hemorrhage

  • Michael DombrowskiEmail author
  • Michael Paidas


Postpartum hemorrhage is an increasingly prevalent and preventable cause of maternal death. We review practical obstetric techniques for management of postpartum hemorrhage. Unfortunately, there is a paucity of data to guide specific interventions for treatment.


Postpartum hemorrhage Uterotonic Balloon tamponade Uterine atony 


  1. 1.
    Likis FE, et al. Management of postpartum hemorrhage. USA: Agency for Healthcare Research and Quality; 2015.Google Scholar
  2. 2.
    Sharp HT, Johnson JV, Lemieux LA, Currigan SM. Executive summary of the reVITALize initiative: standardizing gynecologic data definitions. Obstet Gynecol. 2017;129:603–7.CrossRefPubMedGoogle Scholar
  3. 3.
  4. 4.
    Committee on Practice Bulletins-Obstetrics. Practice bulletin no. 183: postpartum hemorrhage. Obstet Gynecol. 2017;130:e168–86.CrossRefGoogle Scholar
  5. 5.
    Begley CM, Gyte GM, Devane D, McGuire W, Weeks A. Active versus expectant management for women in the third stage of labour. In: The Cochrane Collaboration, editor. Cochrane database of systematic reviews. Hoboken, NJ: John Wiley & Sons, Ltd; 2015. Scholar
  6. 6.
    Mousa HA, Blum J, Abou El Senoun G, Shakur H, Alfirevic Z. Treatment for primary postpartum haemorrhage. Cochrane Database Syst Rev 2014;(2):CD003249. doi:
  7. 7.
    Revert M, et al. Intrauterine balloon tamponade for management of severe postpartum haemorrhage in a perinatal network: a prospective cohort study. BJOG Int J Obstet Gynaecol. 2017;124:1255–62.CrossRefGoogle Scholar
  8. 8.
    Son M, et al. Is there an association between indication for intrauterine balloon tamponade and balloon failure? Am J Perinatol. 2016;34:164–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Matsubara S, et al. A novel ‘uterine sandwich’ for haemorrhage at caesarean section for placenta praevia. Aust N Z J Obstet Gynaecol. 2014;54:283–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Matsubara S, et al. Uterine compression sutures for postpartum hemorrhage: an overview. Acta Obstet Gynecol Scand. 2013;92:378–85.CrossRefPubMedGoogle Scholar
  11. 11.
    Kayem G, et al. Specific second-line therapies for postpartum haemorrhage: a national cohort study: specific second-line therapies for postpartum haemorrhage. BJOG Int J Obstet Gynaecol. 2011;118:856–64.CrossRefGoogle Scholar
  12. 12.
    Distefano M, et al. Selective arterial embolization as a first-line treatment for postpartum hematomas. Obstet Gynecol. 2013;121:443–7.PubMedGoogle Scholar
  13. 13.
    Doumouchtsis S, Nikolopoulos K, Talaulikar V, Krishna A, Arulkumaran S. Menstrual and fertility outcomes following the surgical management of postpartum haemorrhage: a systematic review. BJOG Int J Obstet Gynaecol. 2014;121:382–8.CrossRefGoogle Scholar
  14. 14.
    de la Cruz CZ, Thompson EL, O’Rourke K, Nembhard WN. Cesarean section and the risk of emergency peripartum hysterectomy in high-income countries: a systematic review. Arch Gynecol Obstet. 2015;292:1201–15.CrossRefPubMedGoogle Scholar
  15. 15.
    Rossi AC, Lee RH, Chmait RH. Emergency postpartum hysterectomy for uncontrolled postpartum bleeding: a systematic review. Obstet Gynecol. 2010;115:637–44.CrossRefPubMedGoogle Scholar
  16. 16.
    Brenner M, et al. Use of resuscitative endovascular balloon occlusion of the aorta for proximal aortic control in patients with severe hemorrhage and arrest. JAMA Surg. 2018;153:130–5. Scholar
  17. 17.
    Bergström A. Aorta compression. 2017. Accessed 3 Nov 2017.
  18. 18.
    Riley DP, Burgess RW. External abdominal aortic compression: a study of a resuscitation manoeuvre for postpartum haemorrhage. Anaesth Intensive Care. 1994;22:571–5.PubMedGoogle Scholar
  19. 19.
    Soltan MH, Faragallah MF, Mosabah MH, Al-adawy AR. External aortic compression device: the first aid for postpartum hemorrhage control. J Obstet Gynaecol Res. 2009;35:453–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Soltan MH, Imam HH, Zahran KA, Atallah SM. Assessing changes in flow velocimetry and clinical outcome following use of an external aortic compression device in women with postpartum hemorrhage. Int J Gynecol Obstet. 2010;110:257–61.CrossRefGoogle Scholar
  21. 21.
    ER-REBOATM Catheter—Prytime Medical. 2017. Accessed 3 Nov 2017.
  22. 22.
    510(k) Premarket Notification. 2017. Accessed 3 Nov 2017.
  23. 23.
    Okada A, et al. Resuscitative endovascular balloon occlusion of the aorta as an adjunct for hemorrhagic shock due to uterine rupture: a case report. Clin Case Rep. 2017;5:1565–8.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Stensaeth KH, Sovik E, Haig INY, Skomedal E, Jorgensen A. Fluoroscopy-free resuscitative endovascular balloon occlusion of the aorta (REBOA) for controlling life threatening postpartum hemorrhage. PLoS One. 2017;12:e0174520.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Cohen MJ, Christie SA. Coagulopathy of trauma. Crit Care Clin. 2017;33:101–18.CrossRefPubMedGoogle Scholar
  26. 26.
    Matsukawa T, Sessler DI, Christensen R, Ozaki M, Schroeder M. Heat flow and distribution during epidural anesthesia. Anesthesiology. 1995;83:961–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Cobb B, Cho Y, Hilton G, Ting V, Carvalho B. Active warming utilizing combined IV fluid and forced-air warming decreases hypothermia and improves maternal comfort during cesarean delivery: a randomized control trial. Anesth Analg. 2016;122:1490–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Rotondo MF, et al. ‘Damage control’: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma. 1993;35:375–82.; discussion 382–3.CrossRefPubMedGoogle Scholar
  29. 29.
    Moore EE, Burch JM, Franciose RJ, Offner PJ, Biffl WL. Staged physiologic restoration and damage control surgery. World J Surg. 1998;22:1184–91.CrossRefPubMedGoogle Scholar
  30. 30.
    Deffieux X, Vinchant M, Wigniolle I, Goffinet F, Sentilhes L. Maternal outcome after abdominal packing for uncontrolled postpartum hemorrhage despite peripartum hysterectomy. PLoS One. 2017;12:e0177092.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Dildy GA, Scott JR, Saffer CS, Belfort MA. An effective pressure pack for severe pelvic hemorrhage. Obstet Gynecol. 2006;108:1222–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Section of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive SciencesYale School of Medicine, Yale Women and Children’s Center for Blood Disorders and Preeclampsia AdvancementNew HavenUSA

Personalised recommendations