ACUTE POSTPARTUM HEMORRHAGE

Course overview

OBSTETRIC HEMORRHAGE IS THE MOST COMMON AND DANGEROUS COMPLICATION OF CHILDBIRTH. TRADITIONALLY, POSTPARTUM HEMORRHAGE (PPH) HAS BEEN DEFINED AS GREATER THAN 500 ML ESTIMATED BLOOD LOSS ASSOCIATED WITH VAGINAL DELIVERY OR GREATER THAN 1000 ML ESTIMATED BLOOD LOSS ASSOCIATED WITH CESAREAN DELIVERY. THIS WAS REDEFINED BY THE AMERICAN COLLEGE OF OBSTETRICS AND GYNECOLOGY IN 2017, AND THE CURRENT DEFINITION IS CUMULATIVE BLOOD LOSS GREATER THAN 1000 ML WITH SIGNS AND SYMPTOMS OF HYPOVOLEMIA WITHIN 24 HOURS OF THE BIRTH PROCESS, REGARDLESS OF THE ROUTE OF DELIVERY. WHILE THIS CHANGE WAS MADE WITH THE KNOWLEDGE THAT BLOOD LOSS AT THE TIME OF DELIVERY IS ROUTINELY UNDERESTIMATED, BLOOD LOSS AT THE TIME OF VAGINAL DELIVERY GREATER THAN 500 ML SHOULD BE CONSIDERED ABNORMAL WITH THE POTENTIAL NEED FOR INTERVENTION. PRIMARY POSTPARTUM HEMORRHAGE IS BLEEDING THAT OCCURS IN THE FIRST 24 HOURS AFTER DELIVERY, WHILE SECONDARY POSTPARTUM HEMORRHAGE IS CHARACTERIZED AS BLEEDING THAT OCCURS 24 HOURS TO 12 WEEKS POSTPARTUM. THIS ACTIVITY REVIEWS THE CAUSES OF POSTPARTUM HEMORRHAGE AND HIGHLIGHTS THE ROLE OF THE INTERPROFESSIONAL TEAM IN THE MANAGEMENT OF THESE PATIENTS.