gynecology and obstetrics
Postpartum Hemorrhage
Key Points
Before delivery, assess risk of postpartum hemorrhage, including identification of antenatal risk factors (eg, bleeding disorders, multifetal pregnancy, polyhydramnios, an abnormally large fetus, grand multiparity). Postpartum hemorrhage assessment tools are widely available and can be adjusted for the specific patient population. Replenish intravascular volume, repair genital lacerations, and remove retained placental tissues. Massage the uterus and, if necessary, use uterotonics (eg,oxytocin, prostaglandins,methylergonovine). If hemorrhage persists, consider use of an intrauterine vacuum device, intrauterine balloon tamponade, packing, surgical procedures, and transfusion of blood products. For women at risk, deliver slowly and without unnecessary interventions. 