Postpartum Hemorrhage: What’s New?
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Purpose of Review
Postpartum hemorrhage (PPH) remains an important cause of maternal morbidity and mortality in the USA and in particular worldwide. Recent epidemiological studies have enhanced our ability to identify risk factors for PPH. Novel diagnostic, surgical, and pharmaceutical techniques present opportunities for improving our care of patients with PPH.
This review aims to highlight recent primary research in the field of PPH. Large studies have refuted some assumed risk factors for PPH, including high body mass index and scheduled repeat cesarean delivery. Non-white race is an increasingly important risk factor for major maternal morbidity in the USA. New studies evaluated the role of tranexamic acid, point-of-care tests such as rotational thromboelastometry, uterotonic agents, and cell salvage in the management of PPH.
Attention to and preparation for PPH, especially in patients with significant risk factors, may allow early intervention and improved patient outcomes. Obstetric units should have protocols that use uterotonic agents for PPH prevention and treatment, and tranexamic acid for treatment only. Centers treating the highest risk patients may benefit from having point-of-care testing and cell salvage available.
KeywordsPostpartum hemorrhage Obstetric hemorrhage Quantitative blood loss Cell salvage Rotational thromboelastometry Tranexamic acid
Compliance with Ethical Standards
Conflict of Interest
John C. Markley, MD, PhD, and Daneila A. Carusi, MD, MSc, declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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