Postpartum haemorrhage: a focus on haematological management

Abstract

Postpartum haemorrhage (PPH) results from the failure of normal obstetrical, surgical and/or systemic haemostasis. On a global scale, PPH is responsible for 25% of the estimated 358 000 maternal deaths each year. Primary prevention of PPH begins with an assessment of risk factors, acknowledging that the majority of women who develop PPH have no identifiable risk factors. All pregnant women must therefore be considered to be at risk of major hemorrhage. Women identified to be at high risk of PPH should be delivered in a centre with access to adequately trained staff and an onsite blood bank. A critical feature of massive haemorrhage in obstetrics is the development of disseminated intravascular coagulation (DIC). This is frequently an early feature, in contrast to DIC that develops with haemorrhage from surgery or trauma. There are likely to be similarities in management of transfusion in severe PPH to that of major bleeding in other clinical situations but the pathophysiological processes that contribute to massive PPH may necessitate different transfusion strategies; however, data from clinical trial are lacking. Early recognition and response to severe PPH by a multidisciplinary team has the potential to reduce morbidity and mortality of this common obstetric emergency.