5-Minute Emergency Consult
Postpartum Hemorrhage
Postpartum Hemorrhage is a topic covered in the 5-Minute Emergency Consult.
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Basics
Description
Description
- Postpartum hemorrhage (PPH) after 20 wk gestation
- Primary: Hemorrhage occurring ≤24 hr after delivery:
- Also known as early PPH
- Secondary: Hemorrhage occurring 24 hr–12 wk after delivery:
- Also known as delayed PPH
- Definitions:
- >500 mL after vaginal delivery
- >1,000 mL after C-section
- Occurs in 4% of vaginal deliveries
- Occurs in 6% of C-sections
- Accounts for 25% of pregnancy-related deaths
- ∼50% of postpartum deaths are due to PPH
- 95% of PPH caused by:
- Uterine atony (50–60%)
- Retained placenta (20–30%)
- Cervical/vaginal lacerations (10%)
- Complications:
- Hypovolemic shock
- Blood transfusion
- Acute respiratory distress syndrome
- Renal and/or hepatic failure
- Sheehan syndrome (postpartum pituitary necrosis)
- Loss of fertility
- Disseminated intravascular coagulopathy (DIC)
ALERT
Leading cause of death in pregnancy worldwide
Etiology
Etiology
- 4 Ts of primary PPH:
- Tone:
- Uterine atony
- Tissue
- Lower genital lacerations
- Retained placental tissue
- Trauma
- Placenta accreta
- Uterine rupture
- Uterine inversion
- Ovarian or splenic artery rupture
- Puerperal hematoma
- Genital tract trauma
- Thrombin
- Coagulopathy (ITP, TTP, von Willebrand, DIC)
- Tone:
- Causes of secondary PPH:
- Retained products of conception
- Postpartum endometritis
- Withdrawal of exogenous estrogen
- Puerperal hematoma
- Associated conditions:
- If bleeding is present at other sites, consider coagulopathy
- Risk factors:
- Prior PPH
- Advanced maternal age
- Multiple gestations
- Prolonged labor
- Polyhydramnios
- Instrument-assisted delivery
- Fetal demise
- Anticoagulation therapy
- Placental abruption
- Fibroids
- Prolonged use of oxytocin
- C-section (especially emergent)
- Placenta previa and accreta
- Chorioamnionitis
- General anesthesia
- Large fetus/infant
- Obesity
- Pyrexia
-- To view the remaining sections of this topic, please sign in or purchase a subscription --
Basics
Description
Description
- Postpartum hemorrhage (PPH) after 20 wk gestation
- Primary: Hemorrhage occurring ≤24 hr after delivery:
- Also known as early PPH
- Secondary: Hemorrhage occurring 24 hr–12 wk after delivery:
- Also known as delayed PPH
- Definitions:
- >500 mL after vaginal delivery
- >1,000 mL after C-section
- Occurs in 4% of vaginal deliveries
- Occurs in 6% of C-sections
- Accounts for 25% of pregnancy-related deaths
- ∼50% of postpartum deaths are due to PPH
- 95% of PPH caused by:
- Uterine atony (50–60%)
- Retained placenta (20–30%)
- Cervical/vaginal lacerations (10%)
- Complications:
- Hypovolemic shock
- Blood transfusion
- Acute respiratory distress syndrome
- Renal and/or hepatic failure
- Sheehan syndrome (postpartum pituitary necrosis)
- Loss of fertility
- Disseminated intravascular coagulopathy (DIC)
ALERT
Leading cause of death in pregnancy worldwide
Etiology
Etiology
- 4 Ts of primary PPH:
- Tone:
- Uterine atony
- Tissue
- Lower genital lacerations
- Retained placental tissue
- Trauma
- Placenta accreta
- Uterine rupture
- Uterine inversion
- Ovarian or splenic artery rupture
- Puerperal hematoma
- Genital tract trauma
- Thrombin
- Coagulopathy (ITP, TTP, von Willebrand, DIC)
- Tone:
- Causes of secondary PPH:
- Retained products of conception
- Postpartum endometritis
- Withdrawal of exogenous estrogen
- Puerperal hematoma
- Associated conditions:
- If bleeding is present at other sites, consider coagulopathy
- Risk factors:
- Prior PPH
- Advanced maternal age
- Multiple gestations
- Prolonged labor
- Polyhydramnios
- Instrument-assisted delivery
- Fetal demise
- Anticoagulation therapy
- Placental abruption
- Fibroids
- Prolonged use of oxytocin
- C-section (especially emergent)
- Placenta previa and accreta
- Chorioamnionitis
- General anesthesia
- Large fetus/infant
- Obesity
- Pyrexia
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Citation
Rosen, Peter, et al., editors. "Postpartum Hemorrhage." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307420/5.0/Postpartum_Hemorrhage.
Postpartum Hemorrhage. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307420/5.0/Postpartum_Hemorrhage. Accessed June 7, 2020.
Postpartum Hemorrhage. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult (5th edition). Lippincott Williams & Wilkins. Retrieved June 07, 2020, from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307420/5.0/Postpartum_Hemorrhage
Postpartum Hemorrhage [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2020 June 07]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307420/5.0/Postpartum_Hemorrhage.
* Article titles in AMA citation format should be in sentence-case
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T1 - Postpartum Hemorrhage
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ED - Rosen,Peter,
ED - Shayne,Philip,
ED - Barkin,Adam Z,
ED - Wolfe,Richard E,
ED - Hayden,Stephen R,
ED - Barkin,Roger M,
ED - Schaider,Jeffrey J,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307420/5.0/Postpartum_Hemorrhage
PB - Lippincott Williams & Wilkins
ET - 5
DB - Emergency Central
DP - Unbound Medicine
ER -
