Postpartum Hemorrhage: The Challenges

Postpartum hemorrhage (PPH) is hemorrhagic shock, a life threatening, emergency condition. It is defined as blood loss greater than 500 ml or more within 24 hours after birth. PPH occurs in approximately 3% of vaginal births and 6.4% of cesarean births.

PPH is a consistent cause of preventable maternal death.

  • PPH is the leading cause of maternal mortality in low-income countries, where 99% of maternal deaths occur.
  • Worldwide, PPH is the primary cause of nearly 25% of all maternal deaths.
  • PPH is responsible for 17% of all maternal deaths in the U.S.
  • In Wisconsin, there were nine maternal deaths due to PPH between 1998-2005.

Most deaths occur because of delays in recognizing the early signs and treating them immediately. Every birthing hospital should have a protocol in place for the prevention and management of postpartum hemorrhage.

Prevention of PPH: There are few known risk factors for postpartum hemorrhage. Those that are known include previous cesarean, previous PPH, multiparity, and previous uterine surgery.

  • Two- thirds of women with postpartum hemorrhage have NO risk factors.
  • Black and nonwhite women have almost 3 times the risk of death from hemorrhage than white women

Identification of PPH:
Early identification is a challenge for providers. Normal vital signs do not preclude blood loss in excess of 500 cc, as patients may lose up to 900 cc without any alteration in pulse, BP or respirations.

Intervention and Management of PPH:
Because PPH is not an every-day occurrence in many facilities in the United States, some facilities lack staff with experience with identifying PPH and managing intervention and treatment. This emphasizes the need for obstetrical emergency drills.

Maternal Mortality in Wisconsin, 1998-2005, Wisconsin Association for Perinatal Care, 2008.

Preventing Postpartum Hemorrhage: A Matter of Patient Safety, Wisconsin Association for Perinatal Care, 2009.

WHO recommendations for the prevention and treatment of postpartum haemorrhage, World Health Organization, 2012.

Next: What We Are Doing