Prevention and treatment of postpartum hemorrhage: Focus on hematological aspects of management

Abstract

Postpartum hemorrhage (PPH) is the leading cause of global maternal mortality and accounts for approximately one-quarter of all maternal deaths worldwide. Prevention of excess maternal deaths requires a coordinated approach to prevention, early recognition, and intervention by a multidisciplinary team. Although some women have risk factors for PPH that can be identified during pregnancy or during labor or birth, most women with severe PPH do not have any risk factors. Therefore, all pregnant women must be considered to be at risk of PPH. Common causes include uterine atony, retained placenta, trauma to the genital tract or uterus, and coagulopathy. The pivotal role of fibrinogen and hyperfibrinolysis in the evolution and as a treatment target for PPH is increasingly recognized. Coagulopathy can be an early feature in PPH that may be unrecognized, as it can be present before massive transfusion has occurred. Identification of coagulopathy by viscoelastic point-of-care testing or conventional laboratory assays can be helpful in guiding management of PPH and preventing severe maternal outcomes.