Postpartum Hemorrhage Questions & Answers

1. Centers for Disease Control and Prevention. Reproductive Health: Pregnancy Mortality Surveillance System. Available at https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pmss.html. June 29, 2017; Accessed: July 21, 2017.

2. WHO. Reducing the Global Burden: Postpartum Haemorrhage. Making Pregnancy Safer. 2007. [Full Text].

3. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006: postpartum hemorrhage. Obstet Gynecol. 2006 Oct. 108(4):1039-47. [QxMD MEDLINE Link].

4. Lutomski J, Byrne B, Devane D, Greene R. Increasing trends in atonic postpartum haemorrhage in Ireland: an 11-year population-based cohort study. BJOG. 2012 Feb. 119(3):306-14. [QxMD MEDLINE Link].

5. Baskett TF. Complications of the third stage of labour. Essential Management of Obstetrical Emergencies. 3rd ed. Bristol, England: Clinical Press; 1999. 196-201.

6. Sentilhes L, Vayssière C, Deneux-Tharaux C, et al. Postpartum hemorrhage: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF): in collaboration with the French Society of Anesthesiology and Intensive Care (SFAR). Eur J Obstet Gynecol Reprod Biol. 2016 Mar. 198:12-21. [QxMD MEDLINE Link].

7. Cunningham FG, Gant NF, Leveno KJ, et al, eds. Conduct of normal labor and delivery. Williams Obstetrics. 21st ed. New York, NY: McGraw-Hill; 2001. 320-5.

8. Rogers J, Wood J, McCandlish R, Ayers S, Truesdale A, Elbourne D. Active versus expectant management of third stage of labour: the Hinchingbrooke randomised controlled trial. Lancet. 1998 Mar 7. 351(9104):693-9. [QxMD MEDLINE Link].

9. Begley CM, Gyte GM, Devane D, McGuire W, Weeks A. Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev. 2015 Mar 2. CD007412. [QxMD MEDLINE Link].

10. Jackson KW Jr, Allbert JR, Schemmer GK, Elliot M, Humphrey A, Taylor J. A randomized controlled trial comparing oxytocin administration before and after placental delivery in the prevention of postpartum hemorrhage. Am J Obstet Gynecol. 2001 Oct. 185(4):873-7. [QxMD MEDLINE Link].

11. Sheiner E, Sarid L, Levy A, Seidman DS, Hallak M. Obstetric risk factors and outcome of pregnancies complicated with early postpartum hemorrhage: a population-based study. J Matern Fetal Neonatal Med. 2005 Sep. 18(3):149-54. [QxMD MEDLINE Link].

12. Blomberg M. Maternal obesity and risk of postpartum hemorrhage. Obstet Gynecol. 2011 Sep. 118(3):561-8. [QxMD MEDLINE Link].

13. Hanley GE, Smolina K, Mintzes B, Oberlander TF, Morgan SG. Postpartum Hemorrhage and Use of Serotonin Reuptake Inhibitor Antidepressants in Pregnancy. Obstet Gynecol. 2016 Mar. 127 (3):553-61. [QxMD MEDLINE Link].

14. Haelle T. Venlafaxine Tied to Increased Postpartum Hemorrhage Risk. Medscape Medical News. Available at http://www.medscape.com/viewarticle/858900. February 15, 2016; Accessed: March 2, 2016.

15. Society of Obstetrics and Gynecology of Canada. Postpartum hemorrhage. ALARM Manual. 15th Ed. 2008.

16. Rogers MS, Yuen PM, Wong S. Avoiding manual removal of placenta: evaluation of intra-umbilical injection of uterotonics using the Pipingas technique for management of adherent placenta. Acta Obstet Gynecol Scand. 2007. 86(1):48-54. [QxMD MEDLINE Link].

17. Marquette GP, Skoll MA, Dontigny L. A randomized trial comparing oral misoprostol with intra-amniotic prostaglandin F2alpha for second trimester terminations. J Obstet Gynaecol Can. 2005 Nov. 27(11):1013-8. [QxMD MEDLINE Link].

18. [Guideline] James AH, Kouides PA, Abdul-Kadir R, et al. Von Willebrand disease and other bleeding disorders in women: consensus on diagnosis and management from an international expert panel. Am J Obstet Gynecol. 2009 Jul. 201(1):12.e1-8. [QxMD MEDLINE Link].

19. Khan GQ, John IS, Wani S, Doherty T, Sibai BM. Controlled cord traction versus minimal intervention techniques in delivery of the placenta: a randomized controlled trial. Am J Obstet Gynecol. 1997 Oct. 177(4):770-4. [QxMD MEDLINE Link].

20. McDonald S, Abbott JM, Higgins SP. Prophylactic ergometrine-oxytocin versus oxytocin for the third stage of labour. Cochrane Database Syst Rev. 2004. (1):CD000201.

21. Westhoff G, Cotter AM, Tolosa JE. Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage. Cochrane Database Syst Rev. 2013 Oct 30. CD001808. [QxMD MEDLINE Link].

22. Dansereau J, Joshi AK, Helewa ME, et al. Double-blind comparison of carbetocin versus oxytocin in prevention of uterine atony after cesarean section. Am J Obstet Gynecol. 1999 Mar. 180(3 Pt 1):670-6. [QxMD MEDLINE Link].

23. Oladapo OT, Fawole B, Blum J, Abalos E. Advance distribution of misoprostol for preventing and treating excessive blood loss after birth. Cochrane Database of Systematic Reviews. February 15, 2012.

24. American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care. 4th ed. Elk Grove Village, Ill: American Academy of Pediatrics; 1997.

25. American College of Obstetricians and Gynecologists. ACOG educational bulletin. Hemorrhagic shock. Number 235, April 1997 (replaces no. 82, December 1984). American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 1997 May. 57(2):219-26. [QxMD MEDLINE Link].

26. Schuurmans N, MacKinnon K, Lane C, Etches D. Prevention and management of postpartum haemorrhage. J Soc Obstet Gynaecol Can. 2000. 22 (4):271-81.

27. Van Wolfswinkel ME, Zwart JJ, Schutte JM, Duvekot JJ, Pel M, Van Roosmalen J. Maternal mortality and serious maternal morbidity in Jehovah's witnesses in The Netherlands. BJOG. 2009 Jul. 116(8):1103-8.

28. Singla AK, Lapinski RH, Berkowitz RL, Saphier CJ. Are women who are Jehovah's Witnesses at risk of maternal death?. Am J Obstet Gynecol. 2001 Oct. 185(4):893-5. [QxMD MEDLINE Link].

29. Xiong X, Buekens P, Alexander S, Demianczuk N, Wollast E. Anemia during pregnancy and birth outcome: a meta-analysis. Am J Perinatol. 2000. 17(3):137-46. [QxMD MEDLINE Link].

30. Stainsby D, MacLennan S, Hamilton PJ. Management of massive blood loss: a template guideline. Br J Anaesth. 2000 Sep. 85(3):487-91. [QxMD MEDLINE Link].

31. Bonnar J. Massive obstetric haemorrhage. Baillieres Best Pract Res Clin Obstet Gynaecol. 2000 Feb. 14(1):1-18. [QxMD MEDLINE Link].

32. WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017 May 27. 389 (10084):2105-2116. [QxMD MEDLINE Link].

33. Stoneham MD. An evaluation of methods of increasing the flow rate of i.v. fluid administration. Br J Anaesth. 1995 Sep. 75(3):361-5. [QxMD MEDLINE Link].

34. Choi PT, Yip G, Quinonez LG, Cook DJ. Crystalloids vs. colloids in fluid resuscitation: a systematic review. Crit Care Med. 1999 Jan. 27(1):200-10. [QxMD MEDLINE Link].

35. Roberts I, Alderson P, Bunn F, Chinnock P, Ker K, Schierhout G. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2004 Oct. 18:(4):CD000567.

36. Hewitt PE, Machin SJ. Massive blood transfusion. ABC or Transfusion. London, England: BMJ Publishing; 1998. 49-52.

37. Hughes DB, Ullery BW, Barie PS. The contemporary approach to the care of Jehovah's witnesses. J Trauma. 2008 Jul. 65(1):237-47. [QxMD MEDLINE Link].

38. Atoyebi W, Mundy N, Croxton T, Littlewood TJ, Murphy MF. Is it necessary to administer anti-D to prevent RhD immunization after the transfusion of RhD-positive platelet concentrates?. Br J Haematol. 2000 Dec. 111(3):980-3. [QxMD MEDLINE Link].

39. Franchini M, Franchi M, Bergamini V, Salvagno GL, Montagnana M, Lippi G. A critical review on the use of recombinant factor VIIa in life-threatening obstetric postpartum hemorrhage. Semin Thromb Hemost. 2008 Feb. 34(1):104-12. [QxMD MEDLINE Link].

40. Ahonen J, Jokela R, Korttila K. An open non-randomized study of recombinant activated factor VII in major postpartum haemorrhage. Acta Anaesthesiol Scand. 2007 Aug. 51(7):929-36. [QxMD MEDLINE Link].

41. Franchini M, Manzato F, Salvagno GL, Lippi G. Potential role of recombinant activated factor VII for the treatment of severe bleeding associated with disseminated intravascular coagulation: a systematic review. Blood Coagul Fibrinolysis. 2007 Oct. 18(7):589-93. [QxMD MEDLINE Link].

42. Gibbins KJ, Albright CM, Rouse DJ. Postpartum hemorrhage in the developed world: whither misoprostol?. Am J Obstet Gynecol. 2012 Aug 1. [QxMD MEDLINE Link].

43. O'Brien P, El-Refaey H, Gordon A, Geary M, Rodeck CH. Rectally administered misoprostol for the treatment of postpartum hemorrhage unresponsive to oxytocin and ergometrine: a descriptive study. Obstet Gynecol. 1998 Aug. 92(2):212-4. [QxMD MEDLINE Link].

44. Lokugamage AU, Sullivan KR, Niculescu I, et al. A randomized study comparing rectally administered misoprostol versus Syntometrine combined with an oxytocin infusion for the cessation of primary post partum hemorrhage. Acta Obstet Gynecol Scand. 2001 Sep. 80(9):835-9. [QxMD MEDLINE Link].

45. Vaid A, Dadhwal V, Mittal S, Deka D, Misra R, Sharma JB. A randomized controlled trial of prophylactic sublingual misoprostol versus intramuscular methyl-ergometrine versus intramuscular 15-methyl PGF2alpha in active management of third stage of labor. Arch Gynecol Obstet. 2009 Mar 11. [QxMD MEDLINE Link].

46. Tunçalp Ö, Hofmeyr GJ, Gülmezoglu AM. Prostaglandins for preventing postpartum haemorrhage. Cochrane Database Syst Rev. 2012 Aug 15. 18;(3):CD000494. [QxMD MEDLINE Link].

47. Gallos ID, Williams HM, Price MJ, Merriel A, Gee H, Lissauer D, et al. Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis. Cochrane Database Syst Rev. 2018 Apr 25. 4:CD011689. [QxMD MEDLINE Link].

48. Winikoff B, Dabash R, Durocher J, Darwish E, Nguyen TN, León W, et al. Treatment of post-partum haemorrhage with sublingual misoprostol versus oxytocin in women not exposed to oxytocin during labour: a double-blind, randomised, non-inferiority trial. Lancet. 2010 Jan 16. 375(9710):210-6. [QxMD MEDLINE Link].

49. Quibel T, Ghout I, Goffinet F, Salomon LJ, Fort J, Javoise S, et al. Active Management of the Third Stage of Labor With a Combination of Oxytocin and Misoprostol to Prevent Postpartum Hemorrhage: A Randomized Controlled Trial. Obstet Gynecol. 2016 Oct. 128 (4):805-11. [QxMD MEDLINE Link].

50. Diop A, Daff B, Sow M, Blum J, Diagne M, Sloan NL, et al. Oxytocin via Uniject (a prefilled single-use injection) versus oral misoprostol for prevention of postpartum haemorrhage at the community level: a cluster-randomised controlled trial. Lancet Glob Health. 2016 Jan. 4 (1):e37-44. [QxMD MEDLINE Link].

51. Attilakos G, Psaroudakis D, Ash J, Buchanan R, Winter C, Donald F, et al. Carbetocin versus oxytocin for the prevention of postpartum haemorrhage following caesarean section: the results of a double-blind randomised trial. BJOG. 2010 Jul. 117(8):929-36. [QxMD MEDLINE Link].

52. Widmer M, Piaggio G, Nguyen TMH, et al. Heat-Stable Carbetocin versus Oxytocin to Prevent Hemorrhage after Vaginal Birth. N Engl J Med. 2018 Jun 27. [QxMD MEDLINE Link].

53. Criscuolo JL, Kibler MP, Micholet S, et al. [The value of antibiotic prophylaxis during intrauterine procedures during vaginal delivery. A comparative study of 500 patients]. J Gynecol Obstet Biol Reprod (Paris). 1990. 19(7):909-18. [QxMD MEDLINE Link].

54. Hallak M, Dildy GA 3rd, Hurley TJ, Moise KJ Jr. Transvaginal pressure pack for life-threatening pelvic hemorrhage secondary to placenta accreta. Obstet Gynecol. 1991 Nov. 78(5 Pt 2):938-40. [QxMD MEDLINE Link].

55. Maier RC. Control of postpartum hemorrhage with uterine packing. Am J Obstet Gynecol. 1993 Aug. 169(2 Pt 1):317-21; discussion 321-3. [QxMD MEDLINE Link].

56. Seror J, Allouche C, Elhaik S. Use of Sengstaken-Blakemore tube in massive postpartum hemorrhage: a series of 17 cases. Acta Obstet Gynecol Scand. 2005 Jul. 84(7):660-4. [QxMD MEDLINE Link].

57. Akhter S, Begum MR, Kabir Z, Rashid M, Laila TR, Zabeen F. Use of a condom to control massive postpartum hemorrhage. MedGenMed. 2003 Sep 11. 5(3):38. [QxMD MEDLINE Link].

58. Brees C, Hensleigh PA, Miller S, Pelligra R. A non-inflatable anti-shock garment for obstetric hemorrhage. Int J Gynaecol Obstet. 2004 Nov. 87(2):119-24. [QxMD MEDLINE Link].

59. Johanson R, Kumar M, Obhrai M, Young P. Management of massive postpartum haemorrhage: use of a hydrostatic balloon catheter to avoid laparotomy. BJOG. 2001 Apr. 108(4):420-2. [QxMD MEDLINE Link].

60. Propst AM, Thorp JM Jr. Traumatic vulvar hematomas: conservative versus surgical management. South Med J. 1998 Feb. 91(2):144-6. [QxMD MEDLINE Link].

61. Lingam K, Hood V, Carty MJ. Angiographic embolisation in the management of pelvic haemorrhage. BJOG. 2000 Sep. 107(9):1176-8. [QxMD MEDLINE Link].

62. Stanco LM, Schrimmer DB, Paul RH, Mishell DR Jr. Emergency peripartum hysterectomy and associated risk factors. Am J Obstet Gynecol. 1993 Mar. 168(3 Pt 1):879-83. [QxMD MEDLINE Link].

63. Zelop CM, Harlow BL, Frigoletto FD Jr, Safon LE, Saltzman DH. Emergency peripartum hysterectomy. Am J Obstet Gynecol. 1993 May. 168(5):1443-8. [QxMD MEDLINE Link].

64. Doumouchtsis SK, Papageorghiou AT, Arulkumaran S. Systematic review of conservative management of postpartum hemorrhage: what to do when medical treatment fails. Obstet Gynecol Surv. 2007 Aug. 62(8):540-7. [QxMD MEDLINE Link].

65. Plauche WC. Peripartal Hysterectomy. Plauche WC, Morrison JC, O’Sullivan MJ, eds. Surgical Obstetrics. Philadelphia, Pa: WB Saunders; 1992. 447-65.

66. O'Leary JA. Uterine artery ligation in the control of postcesarean hemorrhage. J Reprod Med. 1995 Mar. 40(3):189-93. [QxMD MEDLINE Link].

67. AbdRabbo SA. Stepwise uterine devascularization: a novel technique for management of uncontrolled postpartum hemorrhage with preservation of the uterus. Am J Obstet Gynecol. 1994 Sep. 171(3):694-700. [QxMD MEDLINE Link].

68. Clark SL, Phelan JP, Yeh SY, Bruce SR, Paul RH. Hypogastric artery ligation for obstetric hemorrhage. Obstet Gynecol. 1985 Sep. 66(3):353-6. [QxMD MEDLINE Link].

69. Floyd RC, Morrison JC. Postpartum Hemorrhage. Plauche WC, Morrison JC, O’Sullivan MJ, eds. Surgical Obstetrics. Philadelphia, Pa: WB Saunders; 1992. 373-82.

70. Vedantham S, Goodwin SC, McLucas B, Mohr G. Uterine artery embolization: an underused method of controlling pelvic hemorrhage. Am J Obstet Gynecol. 1997 Apr. 176(4):938-48. [QxMD MEDLINE Link].

71. Pelage JP, Le Dref O, Mateo J, et al. Life-threatening primary postpartum hemorrhage: treatment with emergency selective arterial embolization. Radiology. 1998 Aug. 208(2):359-62. [QxMD MEDLINE Link].

72. Chauleur C, Fanget C, Tourne G, Levy R, Larchez C, Seffert P. Serious primary post-partum hemorrhage, arterial embolization and future fertility: a retrospective study of 46 cases. Hum Reprod. 2008 Jul. 23(7):1553-9. [QxMD MEDLINE Link].

73. Park HS, Shin JH, Yoon HK, et al. Transcatheter Arterial Embolization for Secondary Postpartum Hemorrhage: Outcome in 52 Patients at a Single Tertiary Referral Center. J Vasc Interv Radiol. 2014 Jun 27. [QxMD MEDLINE Link].

74. B-Lynch C, Coker A, Lawal AH, Abu J, Cowen MJ. The B-Lynch surgical technique for the control of massive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported. Br J Obstet Gynaecol. 1997 Mar. 104(3):372-5. [QxMD MEDLINE Link].

75. Price N, B-Lynch C. Technical description of the B-Lynch brace suture for treatment of massive postpartum hemorrhage and review of published cases. Int J Fertil Womens Med. 2005 Jul-Aug. 50(4):148-63. [QxMD MEDLINE Link].

76. Hayman RG, Arulkumaran S, Steer PJ. Uterine compression sutures: surgical management of postpartum hemorrhage. Obstet Gynecol. 2002 Mar. 99(3):502-6. [QxMD MEDLINE Link].

77. Cho JH, Jun HS, Lee CN. Hemostatic suturing technique for uterine bleeding during cesarean delivery. Obstet Gynecol. 2000 Jul. 96(1):129-131. [QxMD MEDLINE Link].

78. Dildy GA 3rd. Postpartum hemorrhage: new management options. Clin Obstet Gynecol. 2002 Jun. 45(2):330-44. [QxMD MEDLINE Link].

79. Anorlu RI, Maholwana B, Hofmeyr GJ. Methods of delivering the placenta at caesarean section. Cochrane Database Syst Rev. 2008 Jul 16. (3):CD004737.

80. Royal College of Obstetricians and Gynaecologists. Green-top guideline no 27. Placenta Praevia: Diagnosis and Management. Available at: http://www.rcog.org.uk/guidelines.asp?PageID=106&GuidelineID=17. London, England: RCOG Press; 2001. [Full Text].

81. Descargues G, Douvrin F, Degre S, Lemoine JP, Marpeau L, Clavier E. Abnormal placentation and selective embolization of the uterine arteries. Eur J Obstet Gynecol Reprod Biol. 2001 Nov. 99(1):47-52. [QxMD MEDLINE Link].

82. Cook DJ, Reeve BK, Guyatt GH, et al. Stress ulcer prophylaxis in critically ill patients. Resolving discordant meta-analyses. JAMA. 1996 Jan 24-31. 275(4):308-14. [QxMD MEDLINE Link].

83. Smaill FM, Grivell RM. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev. 2014 Oct 28. CD007482. [QxMD MEDLINE Link].

84. [Guideline] Escobar MF, Nassar AH, Theron G, et al. FIGO recommendations on the management of postpartum hemorrhage 2022. Int J Gynaecol Obstet. 2022 Mar. 157 Suppl 1:3-50. [QxMD MEDLINE Link]. [Full Text].

85. Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol. 2017 Oct. 130 (4):e168-e186. [QxMD MEDLINE Link].

John R Smith, MD, FACOG, FRCSC Physician in Maternal-Fetal Medicine, Departments of Obstetrics and Gynecology and Diagnostic Imaging, Credit Valley Hospital, Ontario, Canada

John R Smith, MD, FACOG, FRCSC is a member of the following medical societies: American College of Obstetricians and Gynecologists, College of Physicians and Surgeons of Ontario, International Society of Obstetric Medicine, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Michel E Rivlin, MD Former Professor, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine

Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, Royal College of Surgeons of Edinburgh, Royal College of Obstetricians and Gynaecologists

Disclosure: Nothing to disclose.

Ronald M Ramus, MD Professor of Obstetrics and Gynecology, Director, Division of Maternal-Fetal Medicine, Virginia Commonwealth University School of Medicine

Ronald M Ramus, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, Medical Society of Virginia, Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

Barbara G Brennan, MD, PhD, FRCSC, FACOG Associate Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, McMaster University School of Medicine, Canada

Barbara G Brennan, MD, PhD, FRCSC, FACOG is a member of the following medical societies: American College of Obstetricians and Gynecologists, Canadian Medical Protective Association, College of Physicians and Surgeons of Ontario, International Society of Obstetric Medicine, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

• Print this section
• Print the entire contents of
• Print the entire contents of article