November 2002 · Vol. 14, No. 11Managing postpartum hemorrhage: establish a cause
Although postpartum hemorrhage may be both sudden and massive, this condition has only 4 causes: uterine atony, genital-tract lacerations, retained placenta, and coagulopathy. Thus, the first step in management is determining the cause of bleeding.
STEVEN
L.
CLARK,
MDDr. Clark is a professor in the department of OBG, division of maternal-fetal medicine, University of Utah Health Sciences Center, Salt Lake City, Utah.
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KEY POINTS
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The most widely used agent for both prevention and management of postpartum hemorrhage is misoprostol.
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The primary contraindications to 15 methyl prostaglandin F2αre asthma and cyanotic cardiac disease.
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In most cases of failed medical management of uterine atony, hysterectomy is necessary.
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Although routine inspection of the placenta for completeness is essential following every delivery, portions may remain behind even when the delivered placenta appears to be complete.
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While even optimal management may not prevent all maternal deaths, a reasoned and scientific approach to postpartum hemorrhage can dramatically improve maternal outcome.
Still, even with modern blood-banking techniques and effective medical and surgical approaches for combating bleeding, this common obstetric dilemma remains a significant cause of maternal morbidity and, occasionally, mortality—even in developed nations.1
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