Obstetric haemorrhage

Few obstetric emergencies cause greater concern than haemorrhage in late pregnancy and the immediate postpartum period. Massive haemorrhage can occur without forewarning with few reliable clinical indicators available to predict those at greatest risk. Patients may remain haemodynamically stable until a sudden deterioration in condition takes place. In many cases the extent of the bleeding can be unclear as the haemorrhage may be concealed behind the placenta. This article reviews the common causes of ante and postpartum haemorrhage, their associated factors and the immediate and subsequent management of the conditions. A variety of uterotonic agents is available for the treatment of postpartum haemorrhage and a structured approach for their use is required.