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Evaluation and Treatment of Postpartum Hemorrhage

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Emergency Department Management of Obstetric Complications

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Abstract

Despite advances in medical management, postpartum hemorrhage (PPH) remains a significant source of morbidity and mortality. Primary PPH occurs in the first 24 h after delivery; secondary PPH occurs from 24 h up to 6 weeks after delivery. Severe postpartum hemorrhage is defined as blood loss greater than 1000 ml associated with clinical evidence for hypovolemia. Etiologies for both primary and secondary PPH have considerable overlap; most common causes are uterine atony, retained placenta, infection, and coagulopathy. First-line treatments for PPH include bimanual uterine compression, examination for and treatment of cervical and vaginal lacerations, and uterotonic medications, including oxytocin, methylergonovine, and prostaglandin analogs. Early blood transfusion should be considered with sustained blood loss and signs of hypovolemic shock; coagulopathy should be screened for and treated when detected. Endocavity balloon tamponade is a bedside procedure to control hemorrhage when first-line treatments fail to stop bleeding. Second-line interventions, which include uterine artery embolization and emergency hysterectomy, have high complication rates, but may be lifesaving when first-line therapy is unsuccessful.

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Authors and Affiliations

  1. Department of Emergency Medicine, MedStar Georgetown University and MedStar Washington Hospital Center, 110 Irving St NW, Washington, DC, 20010, USA

    Elaine Bromberek M.D.

  2. Department of Emergency Medicine, MedStar Georgetown University Hospital, Washington, DC, USA

    Janet Smereck M.D.

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  1. Elaine Bromberek M.D.
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Correspondence to Elaine Bromberek M.D. .

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  1. MedStar Georgetown University Hospital and MedStar Washington Hospital Center, Georgetown University School of Medicine, Washington, DC, USA

    Joelle Borhart

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Bromberek, E., Smereck, J. (2017). Evaluation and Treatment of Postpartum Hemorrhage. In: Borhart, J. (eds) Emergency Department Management of Obstetric Complications. Springer, Cham. https://doi.org/10.1007/978-3-319-54410-6_8

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  • DOI: https://doi.org/10.1007/978-3-319-54410-6_8

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