[Postpartum hemmorhage: prevention and treatment by arterial embolization and activated recombinant factor VII]

Primary postpartum hemorrhage occurs in 5% of deliveries and is source of serious maternal morbidity. Active management of third stage of labor with oxytocin administration reduces the risk by more than 60%. Hemorrhage is always underestimated. Teamwork with all involved caregivers is necessary. In case of failure or primary care, such as uterine massage, uterotonics and revision of uterus, cervix and vagina, two treatments must be offered to women: arterial embolization and activated recombinant factor VII. Embolization is effective in 75-100% of cases, thus avoiding hysterectomy. When possible, transfer to a center offering embolization shoud be decided early.