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Chapter: Obstetrics and Gynecology: Postpartum Hemorrhage

Postpartum Hemorrhage

It is estimated that, worldwide, 140,000 women die I ofpostpartum hemorrhage (PPH)each year—1 every 4 minutes. More than half of all maternal deaths occur within 24 hours of delivery, most commonly from excessive bleeding.

Postpartum Hemorrhage

It is estimated that, worldwide, 140,000 women die ofpostpartum hemorrhage (PPH)each year—1 every 4 minutes. More than half of all maternal deaths occur within 24 hours of delivery, most commonly from excessive bleeding. In addition to death, serious morbid-ity may follow postpartum hemorrhage. Sequelae include adult respiratory distress syndrome, coagulopathy, shock, loss of fertil-ity, and pituitary necrosis (Sheehan syndrome).

Hemorrhage can be sudden and profuse, or blood loss can occur more insidiously. PPH has been tradition-ally defined as a delivery-associated blood loss in excess of 500 mL for vaginal delivery and 1000 mL for cesarean birth; however, these estimates actually represent the aver-age blood loss for each mode of delivery, respectively. The estimation of blood loss is subjective, introducing wide variance and inaccuracy.

 

Additionally, the same absolute volume loss for a patient weighing 50 kg may have vastly different effects than it would for someone weighing 75 kg, or for a patient with triplets versus a singleton. Thus, it is likely more appropriate and meaningful to use physiologic and objec-tive criteria in defining clinical hemorrhage. Criteria in use include a 10% drop in hematocrit, need for trans-fusion, and signs and symptoms along the spectrum of physiologic effects of blood loss, described below.

 

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