Chapter 4 - Management of major obstetric hemorrhage

Summary

The International Postpartum Hemorrhage Collaborative Group has observed an increasing trend in postpartum hemorrhage (PPH) and its severity in a number of high-resource countries including the UK, Australia, Canada, and the United States. Antenatal optimization of hematinic status may avoid the need for transfusion should a hemorrhage occur. This is particularly important for women with identified risk factors or who refuse blood. Early recognition of physiological derangement is vital and modified obstetric early warning systems, tracking changes in maternal physiology, have been introduced. The physiological changes of pregnancy initially buffer the effects of hemorrhage, so early signs such as tachycardia, decreased urine output and tachypnoea should be sought. The aim is to resuscitate the patient by stopping the bleeding and restoring a circulating blood volume with oxygen-carrying potential. Placenta accreta is most commonly associated with a combination of a low-lying placenta and uterine trauma from an earlier cesarean section (CS).