Intrapartum and postpartum bleeding

Abstract

Intrapartum and postpartum haemorrhage are common and potentially life-threatening problems associated with pregnancy. Haemorrhage appears as an important cause of maternal death in the Confidential Enquiries into Maternal Deaths (CEMD) in successive triennial reports. The chapter will discuss the various causes of intrapartum and postpartum haemorrhage describing the typical history and examination findings for each. Treatments are also discussed. The article concludes with a brief synopsis of the appropriate steps to consider when managing blood loss. The successful management of haemorrhage relies on prompt diagnosis with appropriate replacement of blood loss, realizing that in many situations in obstetrics, blood loss may be concealed. The obstetric population is young and generally healthy. This together with the adaptations of pregnancy means that signs of blood loss (tachycardia and low blood pressure) may not occur until a large amount of circulating blood volume has been lost. Rapid onset of disseminated intravascular coagulation will exacerbate the situation and a rapid downward spiral can lead to disaster for the mother and baby. The CEMD indicates that substandard care is involved in the majority of maternal deaths and this has been a consistent finding. These are clearly preventable deaths and aggressive early treatment of blood loss, robust protocols and rehearsals of the management of haemorrhage involving all relevant staff are necessary if deaths and near misses are to be reduced.