Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-669899f699-swprf Total loading time: 0 Render date: 2025-05-05T14:20:55.419Z Has data issue: false hasContentIssue false

Chapter 71 - Major Obstetric Hemorrhage and Disseminated Intravascular Coagulation (Content last reviewed: 15th December 2018)

from Section 7 - Postnatal Problems

Published online by Cambridge University Press:  15 November 2017

By
Soha A. Tohamy Said
Edited by
David James ,
Philip Steer ,
Carl Weiner ,
Bernard Gonik  and
Stephen Robson
David James
Affiliation:
University of Nottingham
Philip Steer
Affiliation:
Imperial College London
Carl Weiner
Affiliation:
University of Kansas
Bernard Gonik
Affiliation:
Wayne State University, Detroit
Stephen Robson
Affiliation:
University of Newcastle
Get access

Summary

Obstetric hemorrhage may occur before or after delivery, but more than 80% of cases occur postpartum. Postpartum hemorrhage (PPH) can occur rapidly, involve large volumes of blood loss, and be very frightening for both patients and staff. PPH is commonly defined as a loss of > 500 mL following a vaginal delivery or > 1000 mL for a cesarean delivery.

Type
Chapter
Information
High-Risk Pregnancy
Management Options
 , pp. 1985 - 2013
Publisher: Cambridge University Press
First published in: 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Kramer, MS, Berg, C, Abenhaim, H, et al. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstet Gynecol 2013; 209: 449.e1.Google Scholar
Carroli, G, Cuesta, C, Abalos, E, Gulmezoglu, AM. Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Clin Obstet Gynaecol 2008; 22: 999–1012.Google Scholar
Hogan, MC, Foreman, KJ, Naghavi, M, et al. Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet 2010; 375: 1609–23.Google Scholar
Royal College of Obstetricians and Gynaecologists. Prevention and Management of Postpartum Haemorrhage, 2nd edn. Green-top Guideline No. 52. London: RCOG, 2016. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg52 (accessed March 2017).Google Scholar
Royal College of Obstetricians and Gynaecologists. Antepartum Haemorrhage. Green-top Guideline No. 63. London: RCOG, 2011. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg63 (accessed March 2017).Google Scholar
Cheatham, ML, Safcsak, K. Is the evolving management of intra-abdominal hypertension and abdominal compartment syndrome improving survival?. Crit Care Med 2010; 38: 402–7.Google Scholar
Royal College of Obstetricians and Gynaecologists. Placenta Praevia, Placenta Praevia Accreta and Vasa Praevia: Diagnosis and Management. Green-top Guideline No. 27. London: RCOG, 2011. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg27/ (accessed March 2017).Google Scholar
Belfort, MA. Placenta accreta. Publications Committee, Society for Maternal-Fetal Medicine. Am J Obstet Gynecol 2010; 203: 430–9.Google Scholar
Doumouchtsis, SK, Papageoghiou, AT, Arulkumaran, S. Systematic review of conservative management of postpartum haemorrhage: what to do when medical treatment fails. Obstet Gynecol Surv 2007; 62: 540–7.Google Scholar
World Health Organization. World Health Report 2005: Make Every Mother and Child Count. Geneva: WHO, 2005. http://www.who.int/whr/2005/en/ (accessed March 2017).Google Scholar
PATH. Saving mother’s lives: promoting effective strategies for preventing postpartum hemorrhage. http://www.path.org/projects/preventing_postpartum_hemorrhage.php (accessed March 2017).Google Scholar
Solomon, C, Collis, RE, Collins, PW. Haemostatic monitoring during postpartum haemorrhage and implications for management. Br J Anaesth 2012; 109: 851–63.Google Scholar
Eller, AG, Bennett, MA, Sharshiner, M, et al. Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care. Obstet Gynecol 2011; 117: 331–7.Google Scholar
Main, EK, Goffman, D, Scavone, BM, et al. National Partnership for Maternal Safety: consensus bundle on obstetric hemorrhage. Anesth Analg 2015; 121: 142–8.Google Scholar
Allard, S, Green, L, Hunt, BJ. How we manage the haematological aspects of major obstetric haemorrhage. Br J Haematol 2014; 164: 177–88.Google Scholar
Gabbe, SG, Niebyl, JR, Simpson, JL (eds). Obstetrics: Normal and Problem Pregnancies, 4th edn. New York, NY: Churchill Livingstone, 2002.Google Scholar
Silver, RM, Major, H. Maternal coagulation disorders and postpartum hemorrhage. Clin Obstet Gynecol 2010; 53: 252–64.Google Scholar
Collis, RE, Collins, PW. Haemostatic management of obstetric haemorrhage. Anaesthesia 2015; 70 (Suppl. 1): 78–86.Google Scholar
Shields, LE, Wiesner, S, Fulton, J, Pelletreau, B. Comprehensive maternal hemorrhage protocols reduce the use of blood products and improve patient safety. Am J Obstet Gynecol 2015; 212: 272–80.Google Scholar
Fox, S. Preparing for ob/gyn emergencies: ACOG issues tips. MedScape 2014. http://www.medscape.com/viewarticle/820913 (accessed March 2017).Google Scholar
World Health Organization. Worldwide Prevalence of Anaemia 1993–2005: WHO Global Database on Anaemia. Geneva: WHO, 2008. http://www.who.int/vmnis/publications/anaemia_prevalence/en/ (accessed March 2017).Google Scholar
Cantwell, R, Clutton-Brock, T, Cooper, G, et al. Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood safer: 2006–2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011; 118 (Suppl 1): 1–203.Google ScholarPubMed
Lewis, G (ed.). The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers’ Lives: Reviewing Maternal Deaths to Make Motherhood Safer – 2003–2005. The Seventh Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. London: CEMACH, 2007.Google Scholar
Begley, CM, Gyte, GM, Murphy, DJ, et al. Active versus expectant management for women in third stage of labour. Cochrane Database Syst Rev 2010; (7): CD007412.CrossRefGoogle Scholar
Soltani, H, Hutchon, DR, Poulose, TA. Timing of prophylactic uterotonics for the third stage of labour after vaginal birth. Cochrane Database Syst Rev 2010; (8): CD006173.Google Scholar
Anorlu, RI, Maholwana, B, Hofmeyr, GJ. Methods of delivering the placenta at caesarean section. Cochrane Database Syst Rev 2008; (3): CD004737.Google Scholar
Nathan, HL, El Ayadi, A, Hezelgrave, NL, et al. Shock index: an effective predictor of outcome in postpartum haemorrhage? BJOG 2015; 122: 268–75.Google Scholar
Association of Anaesthetists of Great Britain and Ireland. Blood transfusion and the anaesthetist: management of massive haemorrhage. Anaesthesia 2010; 65: 1153–61.Google Scholar
Quantification of blood loss: AWHONN practice brief number 1. J Obstet Gynecol Neonatal Nurs 2015; 44: 158–60.Google Scholar
Al Kadri, HM, Anazi, BK, Tamim, HM. Visual estimation versus gravimetric measurement of postpartum blood loss: a prospective cohort study. Arch Gynecol Obstet 2011; 283: 1207–13.Google Scholar
Royal College of Physicians of Ireland, Health Service Executive. Practice Guideline: Prevention and Management of Primary Postpartum Haemorrhage. Guideline No 17. Dublin: HSE, 2012. http://www.lenus.ie/hse/handle/10147/275632 (accessed March 2017).Google Scholar
Westhoff, G, Cotter, AM, Tolosa, JE. Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage. Cochrane Database Syst Rev 2013; (10): CD001808.Google Scholar
Abalos, E. Choice of uterotonic agents in the active management of the third stage of labour: RHL commentary. WHO Reproductive Health Library. Geneva: World Health Organization, 2009. https://extranet.who.int/rhl/topics/pregnancy-and-childbirth/care-during-childbirth/care-during-labour-3rd-stage/choice-uterotonic-agents-active-management-third-stage-labour (accessed March 2017).Google Scholar
Su, LL, Chong, YS, Samuel, M. Carbetocin for preventing postpartum haemorrhage. Cochrane Database Syst Rev 2012; (4): CD005457.CrossRefGoogle Scholar
Gizzo, S, Patrelli, TS, Gangi, SD, et al. Which uterotonic is better to prevent the postpartum hemorrhage? Latest news in terms of clinical efficacy, side effects, and contraindications: a systematic review. Reprod Sci 2013; 20: 1011–19.Google Scholar
Tunçalp, Ö, Hofmeyr, GJ, Gülmezoglu, AM. Prostaglandins for preventing postpartum haemorrhage. Cochrane Database Syst Rev 2012; (8): CD000494.Google Scholar
Leduc, D, Senikas, V, Lalonde, AB, et al. Active management of the third stage of labour: prevention and treatment of postpartum hemorrhage. J Obstet Gynaecol Can 2009; 31: 980–93.CrossRefGoogle ScholarPubMed
Hofmeyr, GJ, Gülmezoglu, AM, Novikova, N, et al. Misoprostol to prevent and treat postpartum haemorrhage: a systematic review and meta-analysis of maternal deaths and dose-related effects. Bull World Health Organ 2009; 87: 666–77.Google Scholar
Gibbins, KJ, Albright, CM, Rouse, DJ. Postpartum hemorrhage in the developed world: whither misoprostol? Am J Obstet Gynecol 2013; 208: 181–3.Google Scholar
American Congress of Obstetricians and Gynecologists, District II. Management of Obstetric Haemorrhage. Optimizing Protocols in Obstetrics, Series 2. Albany, NY: ACOG, 2012.Google Scholar
Pacheco, LD, Saade, GR, Gei, AF, Hankins, GD. Cutting-edge advances in the medical management of obstetrical hemorrhage. Am J Obstet Gynecol 2011; 205: 526–32.Google Scholar
Georgiou, C. Balloon tamponade in the management of postpartum haemorrhage: a review. BJOG 2009; 116: 748–57.Google Scholar
Grönvall, M, Tikkanen, M, Tallberg, E, Paavonen, J, Stefanovic, V. Use of Bakri balloon tamponade in the treatment of postpartum hemorrhage: a series of 50 cases from a tertiary teaching hospital. Acta Obstet Gynecol Scand 2013; 92: 433–8.Google Scholar
Yoong, W, Ridout, A, Memtsa, M, et al. Application of uterine compression suture in association with intrauterine balloon tamponade (“uterine sandwich”) for postpartum hemorrhage. Acta Obstet Gynecol Scand 2012; 91: 147–51.Google Scholar
Yoong, W, Sivashanmugarajan, V, McMonagle, M, et al. Pelvic and vaginal packing for intractable venous obstetric haemorrhage: practical tips for the obstetrician. Obstetrician & Gynaecologist 2014; 16: 276–80.Google Scholar
Shao, Y, Pradhan, M. Intrauterine gauze packing in primary post partum hemorrhage following caesarean section: a clinical study. Nepal J Obstet Gynaecol 2012; 7: 33–6.Google Scholar
Camuzcuoglu, H, Toy, H, Vural, M, Yildiz, F, Aydın, H. Internal iliac artery ligation for severe postpartum hemorrhage and severe hemorrhage after postpartum hysterectomy. J Obstet Gynaecol Res 2010; 36: 538–43.Google Scholar
James, AH, McLintock, C, Lockhart, E. Postpartum hemorrhage: when uterotonics and sutures fail. Am J Hematol 2012; 87 (Suppl 1): S16–22.Google Scholar
Nanda, S, Singhal, SR. Hayman uterine compression stitch for arresting atonic postpartum hemorrhage: 5 years experience. Taiwan J Obstet Gynecol 2011; 50: 179–81.Google Scholar
Kayem, G, Kurinczuk, JJ, Alfirevic, Z, et al. Uterine compression sutures for the management of severe postpartum haemorrhage. Obstet Gynecol 2011; 117: 14–20.Google Scholar
Zheng, J, Xiong, X, Ma, Q, Zhang, X, Li, M. A new uterine compression suture for postpartum haemorrhage with atony. BJOG 2011; 118: 370–4.Google Scholar
Alouini, S, Coly, S, Mégier, P, et al. Multiple square sutures for postpartum hemorrhage: results and hysteroscopic assessment. Am J Obstet Gynecol 2011; 205: 335.e1–6.Google Scholar
Ganquli, S, Stecker, MS, Pyne, D, et al. Uterine artery embolization in the treatment of postpartum uterine hemorrhage. J Vasc Interv Radiol 2011; 22: 169–76.Google Scholar
Buckley, B. Interventional radiology in abnormal placentation. RANZCOG O & G Magazine 2010; 12: 56.Google Scholar
Kirby, JM, Kachura, JR, Rajan, DK, et al. Arterial embolization for primary postpartum hemorrhage. J Vasc Interv Radiol 2009; 20: 1036–45.Google Scholar
Kim, TH, Lee, HH, Kim, JM, et al. Uterine artery embolization for primary postpartum hemorrhage. Iran J Reprod Med 2013; 11: 511–18.Google Scholar
Giambattista, E, Ossola, MW, Duiella, SF, et al. Predicting factors for emergency peripartum hysterectomy in women with placenta previa. Arch Gynecol Obstet 2012; 285: 901–6.Google Scholar
Wright, JD, Bonanno, C, Shah, M, Gaddipati, S, Devine, P. Peripartum hysterectomy. Obstet Gynecol 2010; 116: 429–34.Google Scholar
Rossi, AC, Lee, RH, Chmait, RH. Emergency postpartum hysterectomy for uncontrolled postpartum bleeding: a systematic review. Obstet Gynecol 2010; 115: 637–44.Google Scholar
Lone, F, Sultan, AH, Thakar, R, et al. Risk factors and management patterns for emergency obstetric hysterectomy over 2 decades. Int J Gynaecol Obstet 2010; 109: 12–15.Google Scholar
Orbach, A, Levy, A, Wiznitzer, A, et al. Peripartum cesarean hysterectomy: critical analysis of risk factors and trends over the years. J Matern Fetal Neonatal Med 2011; 24: 480–4.Google Scholar
Gupta, P, Sahu, RL, Huria, A. Acute uterine inversion: a simple modification of hydrostatic method of treatment. Ann Med Health Sci Res 2014; 4: 264–7.Google Scholar
Antonelli, E, Irion, O, Tolck, P, Morales, M. Subacute uterine inversion: description of a novel replacement technique using the obstetric ventouse. BJOG 2006; 113: 846–7.Google Scholar
Bhalla, R, Wuntakal, R, Odejinmi, F, Khan, RU. Acute inversion of the uterus. Obstetrician & Gynaecologist 2009; 11: 13–18.Google Scholar
Bell, SF, Rayment, R, Collins, PW, Collis, RE. The use of fibrinogen concentrate to correct hypofibrinogenaemia rapidly during obstetric hemorrhage. Int J Obstet Anaesth 2010; 19: 218–34.Google Scholar
Royal College of Obstetricians and Gynaecologists. Blood Transfusions in Obstetrics. Green-top Guideline No. 47. London: RCOG, 2015. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg47 (accessed March 2017).Google Scholar
Hunt, BJ, Allard, S, Keeling, D, et al.; British Committee for Standards in Haematology. A practical guideline for the haematological management of major haemorrhage. Br J Haematol 2015; 170: 788–803. http://onlinelibrary.wiley.com/doi/10.1111/bjh.13580/epdf (accessed March 2017).Google Scholar
Karlsson, O, Jeppsson, A, Hellgren, M. Major obstetric haemorrhage: monitoring with thromboelastography, laboratory analyses or both? Int J Obstet Anesth 2014; 23: 10–17.Google Scholar
De Lange, NM, Lancé, MD, de Groot, R, et al. Obstetric hemorrhage and coagulation: an update. Thromboelastography, thromboelastometry, and conventional coagulation tests in the diagnosis and prediction of postpartum hemorrhage. Obstet Gynecol Surv 2012; 67: 426–35.Google Scholar
Karlsson, O, Sporrong, T, Hillarp, A, Jeppsson, A, Hellgren, M. Prospective longitudinal study of thromboelastography and standard hemostatic laboratory tests in healthy women during normal pregnancy. Anesth Analg 2012; 115: 890–8.Google Scholar
London School of Hygiene & Tropical Medicine Clinical Trials Unit. The WOMAN Trial (World Maternal Antifibrinolytic Trial): tranexamic acid for the treatment of postpartum haemorrhage: an international randomised, double blind placebo controlled trial. http://womantrial.lshtm.ac.uk/ (accessed March 2017).Google Scholar
Lin, Y, Stanworth, S, Birchall, J, Doree, C, Hyde, C. Use of recombinant factor VIIa for the prevention and treatment of bleeding in patients without hemophilia: a systematic review and meta-analysis. CMAJ 2011; 183: E9–19.Google Scholar
Yank, V, Tuohy, CV, Logan, AC, et al. Systematic review: benefits and harms of in-hospital use of recombinant factor VIIa for off-label indications. Ann Intern Med 2011; 154: 529–40.Google Scholar
Kuppurao, L, Wee, M. Perioperative cell salvage. Contin Educ Anaesth Crit Care Pain 2010; 10: 104–8.Google Scholar
Dhariwal, SK, Khan, KS, Allard, S, Wilson, M, Moore, P; SALVO study group. Does current evidence support the use of intraoperative cell salvage in reducing the need for blood transfusion in caesarean section?. Curr Opin Obstet Gynecol 2014; 26: 425–30.Google Scholar
National Institute for Health and Care Excellence. Intraoperative blood cell salvage in obstetrics. NICE Interventional Procedures Guidance IPG144. London: NICE, 2005. https://www.nice.org.uk/guidance/ipg144 (accessed March 2017).Google Scholar
Froessler, B, Dekker, G, Mcauliffe, G. To the rescue: the role of intravenous iron in the management of severe anaemia in the peri-partum setting. Blood Transfusion 2015; 13: 150–2.Google Scholar
Royal College of Obstetricians and Gynaecologists. Maternal Collapse in Pregnancy and the Puerperium. Green-top Guideline No. 56. London: RCOG, 2011. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg56 (accessed March 2017).Google Scholar
Oberg, AS, Hernandez-Diaz, S, Palmsten, K, Almqvist, C, Bateman, BT. Patterns of recurrence of postpartum hemorrhage in a large population-based cohort. Am J Obstet Gynecol 2014; 210: 229.e1–8.Google Scholar
Sharp, GC, Saunders, PT, Greene, SA, Morris, AD, Norman, JE. Intergenerational transmission of postpartum hemorrhage risk: analysis of 2 Scottish birth cohorts. Am J Obstet Gynecol 2014; 211: 51.e1–7.Google Scholar
Wetta, LA, Szychowski, JM, Seals, S, et al. Risk factors for uterine atony/postpartum hemorrhage requiring treatment after vaginal delivery. Am J Obstet Gynecol 2013; 209: 51.e1–6.Google Scholar
Chibber, R, El-Saleh, E, Fadhli, RA, Jassar, WA, Harmi, JA. Uterine rupture and subsequent pregnancy outcome - how safe is it? A 25-year study. J Matern Fetal Neonatal Med 2010; 23: 421–4.Google Scholar
Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Management of Postpartum Haemorrhage (PPH). C-OBs 43. Melbourne: RANZCOG, 2014.Google Scholar
Güngördük, K, Asicioglu, O, Celikkol, O, Olgac, Y, Ark, C. Use of additional oxytocin to reduce blood loss at elective caesarean section: a randomised control trial. Aust N Z J Obstet Gynaecol 2010; 50: 36–9.Google Scholar
Simpson, E, Lin, Y, Stanworth, SJ, et al. Recombinant factor VIIa for the prevention and treatment of bleeding in patients without haemophilia. Cochrane Database Syst Rev 2012; (3): CD005011.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×