Postpartum haemorrhage

Postpartum haemorrhage (PPH) is defined as blood loss of > 500mls and may be primary or secondary

Primary PPH

• occurs within 24 hours
• affects around 5-7% of deliveries
• most common cause of PPH is uterine atony (90% of cases). Other causes include genital trauma and clotting factors

Risk factors for primary PPH include*:

• previous PPH
• prolonged labour
• pre-eclampsia
• increased maternal age
• polyhydramnios
• emergency Caesarean section
• placenta praevia, placenta accreta
• macrosomia
• ritodrine (a beta-2 adrenergic receptor agonist used for tocolysis)

Management

• ABC
• IV syntocinon (oxytocin) 10 units or IV ergometrine 500 micrograms
• IM carboprost
• other options include: B-Lynch suture, ligation of the uterine arteries or internal iliac arteries
• if severe, uncontrolled haemorrhage then a hysterectomy is sometimes performed as a life-saving procedure

Secondary PPH

• occurs between 24 hours - 12 weeks**
• due to retained placental tissue or endometritis

*the effect of parity on the risk of PPH is complicated. It was previously though multiparity was a risk factor but more modern studies suggest nulliparity is actually a risk factor

**previously the definition of secondary PPH was 24 hours - 6 weeks. Please see the RCOG guidelines for more details