|November 2002 · Vol. 14, No. 11
Managing 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.
Dr. Clark is a professor in the department of OBG, division of maternal-fetal medicine, University of Utah Health Sciences Center, Salt Lake City, Utah.
The most widely used agent for both prevention and management of postpartum hemorrhage is misoprostol.
The primary contraindications to 15 methyl prostaglandin F2αre asthma and cyanotic cardiac disease.
In most cases of failed medical management of uterine atony, hysterectomy is necessary.
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.
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