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Postpartum hemorrhage revisited

new challenges and solutions

Higgins, Nicolea; Patel, Samir K.a; Toledo, Palomaa,b

Current Opinion in Anesthesiology: June 2019 - Volume 32 - Issue 3 - p 278–284
doi: 10.1097/ACO.0000000000000717

Purpose of review Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality in the United States, and worldwide. Recognition of PPH is challenging, but once hemorrhage is recognized, management needs to focus on achieving adequate uterine tone and maintaining maternal hemodynamic stability. There have been several advances in the management of postpartum hemorrhage, many of which can be implemented at the labor and delivery unit level.

Recent findings There have been many advances in the understanding of at-risk parturients, and the use of hemorrhage protocols and safety bundles have been shown to improve patient outcomes. There are many new advances in transfusion management (e.g. fibrinogen concentrate, prothrombin complex concentrate, tranexamic acid) that can compliment traditional component therapy. Consideration should be given to transferring women at high risk for complications (e.g. invasive placentation) to a higher level facility for delivery.

Summary Although postpartum hemorrhage itself may not be preventable, early identification of blood loss, and mobilization of resources may prevent adverse outcomes. Multidisciplinary planning at the system level, ensuring that hemorrhage protocols exist, as well as for management of high-risk patients is important for improving patient outcomes.

aDepartment of Anesthesiology

bCenter for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, USA

Correspondence to Paloma Toledo, MD, MPH, Northwestern University Feinberg School of Medicine, 251 E. Huron St. F5-704, Chicago, IL 60611, USA. Tel: + 1 312 472 3585; fax: +1 312 472 3590; e-mail:

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