Coagulopathy in obstetric bleeding: a narrative review and comparison with trauma-induced coagulopathy

Postpartum haemorrhage is the leading cause of maternal mortality and morbidity worldwide. Coagulopathy in postpartum haemorrhage can occur because of the depletion and dilution of clotting factors in association with excessive bleeding. Alternatively, coagulopathy may result from pathological fibrinogen destruction, a process recently described as 'acute obstetric coagulopathy'. Resuscitation guidelines in postpartum haemorrhage are heavily influenced by evidence from studies in nonpregnant trauma populations despite many differences in baseline physiology, cause of haemorrhage and type of coagulopathy. This narrative review explores recent advances in understanding coagulopathy associated with obstetric haemorrhage and compares its pathophysiology and management with that of trauma-induced coagulopathy.