Postpartum Hemorrhage

  • Sheela V. Mane
  • Vijay Kumar Koravi
  • Priyanka Dilip Kumar
  • Meenakshi Kandoria


Hemorrhage, even to this day, is the major killer of pregnant women both in developing and developed countries. Postpartum hemorrhage (PPH) is a dreaded complication of labor and delivery and presents itself not only in women at high risk for the complication but also sometimes in apparently low-risk gravida in the most innocuous and unexpected situations. Global statistics for causes of maternal mortality state that maternal anemia directly or indirectly is responsible in 19.3% of cases, hemorrhage in 23.7%, pregnancy-induced hypertension (PIH) and eclampsia in 13.1%, unsafe abortions in 12.6%, sepsis in 10.6%, obstructed labor in 6.4%, and others in 14.2%. It is obvious that hemorrhage remains the major killer, and healthcare workers need to be alerted and trained to handle this emergency [1].


  1. 1.
    Koblinsky M, Campbell O, Heichelheim J. Organising delivery care. What works for safe motherhood. Bull World Health Organ. 1999;77:399–406.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Combs CA, Murphy EL, Laros RK Jr. Factors associated with postpartum hemorrhage with vaginal birth. Obstet Gynecol. 1991;77:69–76.PubMedGoogle Scholar
  3. 3.
    Bonnar J. Massive obstetric haemorrhage. Bailliers Best Pract Res Clin Obstet Gynaecol. 2000;14:1–18.CrossRefGoogle Scholar
  4. 4.
    Yiadom MY, Carusi D. Postpartum haemorrhage in emergency medicine [online]. Available from: Accessed Mar 2013.
  5. 5.
    Waterstone M, Bewley S, Wolfe C. Incidence and predictors of severe obstetric morbidity: case control study. Br Med J. 2001;322:1089–94.CrossRefGoogle Scholar
  6. 6.
    Charbit B, Mandelbrot L, Samain E, et al. The decrease of fibrinogen is an early predictor of the severity of post partum haemorrhage. J Thromb Haemost. 2007;5:266–73.CrossRefGoogle Scholar
  7. 7.
    Sobieszczyk S, Bręborowicz GH. Management recommendations for post partum hemorrhage. Arch Perinat Med. 2004;m10:53–6.Google Scholar
  8. 8.
    NHS Quality Improvement Scotland. Scottish confidential audit of severe maternal morbidity. 5th Annual report 2007 [online]. Available from: Accessed Mar 2013.
  9. 9.
    Arulkumaran S. Massive and intractable PPH, lessons from confidential inquiries. Available from:
  10. 10.
    Prevention and management of postpartum hemorrhage, RCOG green-top guideline no. 52, May 2009.Google Scholar
  11. 11.
    Lynch CB, Keith LG, Lalond AB, Karoshi M, editors. A textbook of postpartum hemorrhage: a comprehensive guide to evaluation, management and surgical intervention. Dumfriesshire: Sapiens Publishing; 2006.Google Scholar
  12. 12.
    Boucher M, Nimrod CA, Tawagi GF, Meeker TA, Rennicks White RE, Varin J. Comparison of carbetocin and oxytocin for the prevention of postpartum hemorrhage following vaginal delivery: a double-blind randomized trial. J Obstet Gynaecol Can. 2004;26:481–8.CrossRefGoogle Scholar
  13. 13.
    Su LL, Chong YS, Samuel M. Oxytocin agonists for preventing postpartum haemorrhage. Cochrane Database Syst Rev. 2007;3:CD005457.Google Scholar
  14. 14.
    Oleen MA, Mariano JP. Controlling refractory atonic postpartum haemorrhage with Hemabate sterile solution. Am J Obstet Gynecol. 1990;162:205–8.CrossRefGoogle Scholar
  15. 15.
    Ramanathan G, Arulkumaran S. Postpartum hemorrhage. J Obstet Gynaecol Can. 2006;28:967–73.CrossRefGoogle Scholar
  16. 16.
    Atoyebi W, Mundy N, Croxton T, Littlewood TJ, Murphy MF. Is it necessary to administer anti-D to prevent RhD immunization after the transfusion of RhD-positive platelet concentrates? Br J Haematol. 2000;111:980–3.PubMedGoogle Scholar
  17. 17.
    Hewitt PE, Machin SJ. Massive blood transfusion. In: ABC of transfusion. London: BMJ Publishing; 1998. p. 49–52.Google Scholar
  18. 18.
    Franchini M, Manzato F, Salvagno GL, Lippi G. Potential role of recombinant activated factor VII for the treatment of severe bleeding associated with disseminated intravascular coagulation: a systematic review. Blood Coagul Fibrinolysis. 2007;18:589–93.CrossRefGoogle Scholar
  19. 19.
    As KA, Hagen P, Webb JB. Tranexamic acid in the management of postpartum haemorrhage. Br J Obstet Gynaecol. 1996;103:1250–1.CrossRefGoogle Scholar
  20. 20.
    Boehlen F, Morales MA, Fontana P, Ricou B, Irion O, de Moerloose P. Prolonged treatment of massive postpartum haemorrhage with recombinant factor VIIa: case report and review of the literature. BJOG. 2004;111:284–7.CrossRefGoogle Scholar
  21. 21.
    B-Lynch C, Coker A, Lawal AH, Abu J, Cowen MJ. The B-Lynch surgical technique for the control of massive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported. Br J Obstet Gynaecol. 1997;104(3):372–5.Google Scholar
  22. 22.
    Soumunkiran A, Ozdemir I, Demiraran Y, Yucel O. B-Lynch suture after the failure of hypogastric artery ligation to control post-partum hemorrhage due to placenta increta in a patient with the factor V Leiden mutation. J Obstet Gynaecol Res. 2007;33(4):557.CrossRefGoogle Scholar
  23. 23.
    El-Hamamy E, B-Lynch C. A worldwide review of the uses of the uterine compression suture techniques as alternative to hysterectomy in the management of severe post-partum haemorrhage. J Obstet Gynaecol. 2005;25(2):143–9.CrossRefGoogle Scholar
  24. 24.
    B-Lynch C. Conservative surgical management. In: B-Lynch C, Lalonde AB, editors. A textbook of postpartum haemorrhage. Kolkata: Jaypee; 2006. p. 287–98.Google Scholar
  25. 25.
    Tamizian O, Arulkumaran S. The surgical management of post-partum haemorrhage. Best Pract Res Clin Obstet Gynaecol. 2002;16(1):81–98.CrossRefGoogle Scholar
  26. 26.
    Gilstrap LC, Ramin SM. Postpartum Hemorrhage. Clin Obstet Gynecol. 1994;37(4):824–30.CrossRefGoogle Scholar
  27. 27.
    AbdRabbo SA. Stepwise uterine devascularization: a novel technique for management of uncontrolled postpartum haemorrhage with preservation of the uterus. Am J Obstet Gynecol. 1994;171(3):694–700.CrossRefGoogle Scholar
  28. 28.
    Vegas G, Illescas T, Munoz M, Perez-Pinar A. Selective pelvic arterial embolization in the management of obstetric hemorrhage. Eur J Obstet Gynecol Reprod Biol. 2006;127:68–72.CrossRefGoogle Scholar
  29. 29.
    Moore M, Morales JP, Sabharwal T, Oteng-Ntim E, O'Sullivan G. Selective arterial embolisation: a first line measure for obstetric haemorrhage. Int J Obstet Anesth. 2008;17:70–3.CrossRefGoogle Scholar
  30. 30.
    Oei PL, Chua S, Tan L, Ratnam SS, Arulkumaran S. Arterial embolization for bleeding following hysterectomy for intractable post-partum hemorrhage. Int J Gynecol Obstet. 1998;62:83–6.CrossRefGoogle Scholar
  31. 31.
    Yamashita Y, Harada M, Yamamoto H, Miyazaki T, Takahashi M, Miyazaki K, Okamura H. Transcatheter arterial embolization of obstetric & gynaecological bleeding: efficacy & clinical outcome. Br J Radiol. 1994;67(798):530–4.CrossRefGoogle Scholar
  32. 32.
    Morris J, Meyer C, Fathalla MF, Youssif MM, Al-Hussaini TK, Camlin C, Miller S. Treating uterine atony with the NASG in Egypt. Afr J Midwifery Womens Health. 2011;5(1):37–42.CrossRefGoogle Scholar
  33. 33.
    Ojengbede O, Galadanci H, Morhason-Bello IO, Nsima D, Camlin C, Morris J, Butrick E, Meyer C, Mohammed AI, Miller S. The non-pneumatic anti-shock garment for postpartum haemorrhage in Nigeria. Afr J Midwifery Womens Health. 2011;5(3):135–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  • Sheela V. Mane
    • 1
  • Vijay Kumar Koravi
    • 2
  • Priyanka Dilip Kumar
    • 3
  • Meenakshi Kandoria
    • 4
  1. 1.BengaluruIndia
  2. 2.Department of OBGDr. BR Ambedkar Medical CollegeBangaloreIndia
  3. 3.NU Hospital, Jananam Fertility Centre,BangaloreIndia
  4. 4.Department of OBGKamala Nehru State Hospital for Mother and Child, Indira Gandhi Medical College,ShimlaIndia

Personalised recommendations