Anesthesiology pp 517-525 | Cite as

Anesthesia and Major Obstetric Hemorrhage

  • Tekuila CarterEmail author
  • Yasser Sakawi
  • Michelle Tubinis


Obstetric hemorrhage is a major cause of maternal morbidity and accounts for the majority of maternal deaths worldwide. Maternal hemorrhage can occur antepartum or postpartum. The incidence of maternal hemorrhage has increased in the United States and other industrialized nations and has been attributed to the increased rates of uterine atony and the rising rates of cesarean sections. Postpartum hemorrhage (PPH) is the leading cause of intensive care unit (ICU) admission following delivery. Many of the maternal deaths due to hemorrhage have been determined to be preventable. Development of protocols and a team approach for early recognition, prevention of bleeding, preparation, and timely treatment of major obstetric hemorrhage are good strategies to reduce morbidity and mortality.


Maternal hemorrhage Maternal mortality Antepartum hemorrhage Postpartum hemorrhage Abnormal placentation Uterine atony 


  1. 1.
    Kassebaum NJ, Steiner C, Murray CJL, et al. Global, regional, and national levels of maternal mortality, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1775–812.CrossRefGoogle Scholar
  2. 2.
    Callaghan W, Kuklina E, Berg C. Trends in postpartum hemorrhage: United States, 1994–2006. Am J Obstet Gynecol. 2010;202(4):353.e1–6.CrossRefGoogle Scholar
  3. 3.
    Giordano R. Antepartum haemorrhage. J Perinat Med. 2010;4(1):12–6.Google Scholar
  4. 4.
    Faiz Ananth C. Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. J Matern Fetal Neonatal Med. 2003;13(3):175–90.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Silver R. Abnormal Placentation: Placenta previa, Vasa Previa, and Placenta Accreta. Obstet Gynecol. 2015;126(3):654–68.CrossRefPubMedGoogle Scholar
  6. 6.
    Romundstad L, Romundstad P, Sunde A, et al. Increased risk of placenta previa in pregnancies following IVF/ICSI; a comparison of ART and non-ART pregnancies in the same mother. Hum Reprod. 2006;21(9):2353–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Fan D, Wu S, Liu L, Xia Q, Wang W, Guo X, et al. Prevalence of antepartum hemorrhage in women with placenta previa: a systematic review and meta-analysis. Sci Rep. 2017;7:40320.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Crane J, Van der Hof M, Dodds L, Armson BA, Liston R. Maternal complications with placenta previa. Am J Perinatol. 2000;17(2):101–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Ananth C, Wilcox AJ. Placental abruption and perinatal mortality in the United States. Am J Epidemiol. 2001;153(4):332–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Vilchez G, Dai J, Kumar K, Lagos M, Sokol R. Contemporary analysis of maternal and neonatal morbidity after uterine rupture: a nationwide population-based study. J Obstet Gynaecol Res. 2017.Google Scholar
  11. 11.
    Kominiarek MA, Kilpatrick SJ. Postpartum hemorrhage: a recurring pregnancy complication. Semin Perinatol. 2007;31:159–66.CrossRefPubMedGoogle Scholar
  12. 12.
    Bateman BT, Berman MF, Riley LE, Leffert LR. The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg. 2010;110(5):1368–73.CrossRefPubMedGoogle Scholar
  13. 13.
    WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: World Health Organization; 2012.Google Scholar
  14. 14.
    Endler M, Grünewald C, Saltvedt S. Epidemiology of retained placenta. Obstet Gynecol. 2012;119(4):801–9.CrossRefPubMedGoogle Scholar
  15. 15.
    American College of Obstetricians and Gynecologists. Committee Opinion No. 529: placenta accreta. Obstet Gynecol. 2012;120(1):207–11.CrossRefGoogle Scholar
  16. 16.
    Mirza F, Gaddipati S. Obstetric Emergencies. Semin Perinatol. 2009;33(2):97–103.CrossRefPubMedGoogle Scholar
  17. 17.
    ACOG Practice Bulletin No. 76: postpartum hemorrhage. Obstet Gynecol 2006;108(4):1039–48.Google Scholar
  18. 18.
    Cortet M, Deneux-Tharaux C, Dupont C, Colin C, Rudigoz R, Bouvier-Colle M, et al. Association between fibrinogen level and severity of postpartum haemorrhage: secondary analysis of a prospective trial. Br J Anaesth. 2012;108(6):984–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Berg C, Harper M, Atkinson S, Bell E, Brown H, Hage M, et al. Preventability of pregnancy-related deaths. Obstet Gynecol. 2005;106(6):1228–34.CrossRefPubMedGoogle Scholar
  20. 20.
    McClure J, Cooper G, Clutton-Brock T. Saving Mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006-8: a review. Br J Anaesth. 2011;107(2):127–32.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Bose P, Regan F, Paterson-Brown S. Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions. BJOG. 2006;113(8):919–24.CrossRefPubMedGoogle Scholar
  22. 22.
    Lertbunnaphong T, Lapthanapat N, Leetheeragul J, Hakularb P, Ownon A. Postpartum blood loss: visual estimation versus objective quantification with a novel birthing drape. Singap Med J. 2016;57(06):325–8.CrossRefGoogle Scholar
  23. 23.
    Toledo P, Eosakul S, Goetz K, Wong C, Grobman W. Decay in blood loss estimation skills after web-based didactic training. Simul Healthc. 2012;7(1):18–21.CrossRefPubMedGoogle Scholar
  24. 24.
    Sharareh B, Woolwine S, Satish S, Abraham P, Schwarzkopf R. Real time intraoperative monitoring of blood loss with a novel tablet application. Open Orthop J. 2015;9(1):422–6.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Eller A, Bennett M, Sharshiner M, Masheter C, Soisson A, Dodson M, et al. Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care. Obstet Gynecol. 2011;117(2, Part 1):331–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Cotton B, Au B, Nunez T, Gunter O, Robertson A, Young P. Predefined massive transfusion protocols are associated with a reduction in organ failure and postinjury complications. J Trauma. 2009;66(1):41–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Tekuila Carter
    • 1
    Email author
  • Yasser Sakawi
    • 1
  • Michelle Tubinis
    • 1
  1. 1.Department of Anesthesiology and Perioperative MedicineUniversity of Alabama at BirminghamBirminghamUSA

Personalised recommendations