Postpartum haemorrhage remains in the top five causes of maternal deaths in both developed and developing countries. Persistent blood loss of more than 1000 ml should prompt predetermined measures to achieve resuscitation and haemostasis. A protocol including guidelines is given and volume replacement is discussed. The range of medical and surgical interventions that may be considered for the modern management of major haemorrhage unresponsive to oxytocin and ergometrine are presented. The review discusses in depth the use of misoprostol, recombinant activated factor VII, the uterine tamponade procedures, artery ligation, and uterine haemostatic suturing techniques. It also evaluates the place of interventional radiology and hysterectomy in modern obstetrics.
University Department of Obstetrics & Gynaecology, Liverpool Women's Hospital, Liverpool, UK
Correspondence to Dr S.A. Walkinshaw, Fetal Centre, Liverpool Women's Hospital, Crown St., Liverpool, L8 7SS, United Kingdom.. Tel: +44 151 702 4109; fax: +44 151 702 4024; e-mail: firstname.lastname@example.org