Postpartum haemorrhage: prevention and treatment

Area of Science:

• Obstetrics and Gynecology
• Maternal Health
• Public Health

Background:

• Postpartum hemorrhage (PPH) is a leading cause of maternal mortality and morbidity globally.
• Current strategies for PPH prevention and treatment differ among international health authorities.
• Understanding global variations in PPH management is crucial for improving maternal outcomes.

Purpose of the Study:

• To provide a comprehensive global overview of postpartum hemorrhage.
• To review current evidence and international recommendations for PPH prevention and treatment.
• To analyze the incidence, causes, risk factors, and management strategies for PPH.

Main Methods:

• Systematic review of global literature on postpartum hemorrhage.
• Analysis of prevention strategies, including active management of the third stage of labor and prohemostatic agents.
• Evaluation of treatment measures, categorized into first, second, and third-line interventions.
• Inclusion of recommendations from international authorities and relevant algorithms.

Main Results:

• Oxytocin is the preferred first-line agent for PPH prevention and treatment when available.
• Peripartum hysterectomy is reserved as a final life-saving measure for refractory PPH.
• The overall level of evidence supporting PPH prevention and treatment guidelines is low, often due to the challenges of conducting randomized controlled trials (RCTs) in emergency settings.

Conclusions:

• Oxytocin is a cornerstone in PPH management, but its availability and optimal use vary.
• There is a critical need to strengthen the evidence base for PPH interventions.
• Encouraging population-based observational studies is recommended to supplement RCT data for PPH management.