Management of postpartum hemorrhage.

Postpartum hemorrhage remains a source of maternal morbidity and mortality in modern obstetric medicine. While the risk factors for postpartum hemorrhage are well described, many patients who develop this complication have no known antenatal risk factors. Therefore, in every delivery the attending physician must be vigilant for signs of hemorrhage. Paramount to a successful outcome is the efficient enactment of a logical plan. Uterine atony causes more than 90 percent of cases of postpartum hemorrhage. Lower genital tract lacerations and retained placental products are the most common causes of hemorrhage when the uterus is firm. Successful treatment of postpartum hemorrhage requires the prompt recognition of ongoing bleeding, followed by uterine massage and oxytocin administration. The intramuscular administration of ergot or prostaglandin preparations can help with refractory bleeding. Most deaths from postpartum hemorrhage occur not because of brisk blood loss, but because of the ineffective management of continuous low-level bleeding.