Advances in the treatment of postpartum hemorrhage

Alison M El Ayadi*, Nuriya Robinson, Stacie Geller and Suellen Miller Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, 50 Beale Street, Suite 1200, San Francisco, CA 94105, USA Department of Obstetrics and Gynecology, University of Illinois, 820 S. Wood Street, M/C 808, Chicago, IL 60612, USA Department of Obstetrics and Gynecology, Center for Research on Women and Gender, University of Illinois, 820 S. Wood Street, M/C 808, Chicago, IL 60612, USA *Author for correspondence: Tel.: +1 415 597 4979 Fax: +1 415 597 9300 [email protected] Postpartum hemorrhage (PPH) is the largest contributor to maternal mortality, occurring in between 1 and 5% of deliveries. Prophylactic uterotonics are widely recommended to prevent atonic hemorrhage. Rapid recognition of PPH and identification of hemorrhage etiology is essential to reduce mortality and morbidity. Treatment is etiology-specific and comprises a range of medical, mechanical, temporizing and surgical procedures. Important developments from trauma and emergency medicine around massive hemorrhage protocols are newly implemented for PPH, and the evidence base for PPH medical management is expanding, with clinical trials ongoing. Improving the management of PPH in limited-resource settings will require continued attention to ensure the availability of low-cost accessible prevention and treatment options, in addition to a focus on skilled care providers.