[Management of major postpartum hemorrhage]

Area of Science:

• Obstetrics and Gynecology
• Maternal Health
• Hemorrhage Management

Context:

• Postpartum hemorrhage (PPH) affects up to 5% of births, with severe forms occurring in 1%.
• PPH is the primary cause of maternal mortality in France, with 90% of deaths deemed preventable.
• Effective PPH management necessitates a multidisciplinary approach and adherence to time-sensitive treatment protocols.

Purpose:

• To define postpartum hemorrhage (PPH) and outline its incidence and severity.
• To emphasize the critical role of timely and multidisciplinary management in reducing PPH-related maternal mortality.
• To detail the comprehensive treatment strategies for severe PPH, including resuscitation and hemostatic interventions.

Summary:

• Postpartum hemorrhage (PPH) is defined as >500 mL blood loss after vaginal delivery or >1000 mL after cesarean section within 24 hours.
• Severe PPH management involves active resuscitation, hemostatic interventions like embolization, and coagulopathy correction.
• Time is a critical prognostic factor in managing PPH, highlighting the need for rapid and coordinated care.

Impact:

• Highlights the significant maternal mortality associated with PPH, emphasizing its public health importance.
• Underscores the preventability of most PPH-related deaths through timely and appropriate medical intervention.
• Provides a framework for understanding the complex, multidisciplinary management required for severe postpartum hemorrhage.