Introduction

Although childbirth is a wonderful and enjoyable experience by most, it still is an anatomically traumatic event, associated with tissue injury, vascular disruption and the potential for blood loss. All deliveries are accompanied by physiologic hemorrhage from the genital tract, and the abdominal soft tissue in cesarean section (Table 12.1). Post partum hemorrhage (PPH) is an obstetrical complication, which can transform a normal physiologic process of labor and delivery into a life-threatening emergency within minutes. A routine cesarean section can be complicated by massive hemorrhage. The healthy mother may quickly become a patient in the critical care unit, requiring all of the available skill and resources of physicians, nurses, the medical laboratory and the blood bank for survival. A thorough knowledge of the risk factors, preventive strategies, approach to diagnosis and management of PPH are required to properly care for women presenting for delivery. Once PPH is diagnosed, hospital facilities and/or referral centers, laboratories and blood banks must be readily available to provide the optimal chance for a successful outcome. The availability of blood replacement and modern critical care are major determinants of survival in women who develop post partum hemorrhagic shock. Mortality from PPH is strongly correlated with substandard care. Clearly, it is the problem of PPH that most vividly illustrates the difference, worldwide, between management of the puerperium in developed countries from that in underdeveloped countries.