Chapter 39 - Obstetric hemorrhage

Summary

This chapter reviews the epidemiology, etiology, and management measures related to obstetric hemorrhage. Placental abruption is the premature separation of the placenta from the uterus and is implicated in one third of all antepartum hemorrhages. The characteristic clinical presentation of placenta previa is painless vaginal bleeding after 20 weeks of gestation. Treatment options for uterine rupture include surgical repair of the defect or hysterectomy. Oxytocin, methylergonovine, prostaglandin f2, prostaglandin e1 are used in pharmacological management of uterine atony. Uterine tamponade, uterine brace suture, bilateral uterine artery ligation, arterial embolization are some of the non-pharmacological management measures. Genital tract trauma, often associated with operative vaginal delivery, is also a significant cause of postpartum hemorrhage (PPH). Blood component therapy should also be considered if signs of hemodynamic instability persist. Multiple specialties are involved in the care of the hemorrhaging parturient, including obstetricians, anesthesiologists, midwives, hematologists, and occasionally radiologists and intensivists.