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Postpartum Hemorrhage
Kelly C. Wormer; Radia T. Jamil; Suzanne B. Bryant.

Author Information and Affiliations

Last Update: July 19, 2024.

Continuing Education Activity

Postpartum hemorrhage (PPH) poses a significant risk to maternal health and is characterized by
excessive blood loss after delivery. While uterine contractions and the coagulation cascade
primarily regulate blood loss, PPH can lead to severe complications if left untreated. The
traditional definition of PPH, based on blood loss thresholds, has evolved to encompass broader
criteria of a cumulative blood loss of 1000 mL or more of blood loss associated with signs or
symptoms of hypovolemia during any mode of delivery. Primary PPH occurs within 24 hours
postpartum, while secondary PPH happens up to 12 weeks later. Causes, summarized by the 4
"T's" (tone, trauma, tissue, thrombin), require prompt intervention. Management involves an
interprofessional approach, emphasizing accurate blood loss assessment, fluid replacement, and
source control.

This activity for healthcare professionals is designed to enhance the learner's competence in
promptly diagnosing and implementing appropriate interventions for patients with PPH to
improve outcomes. Key elements include maintaining patient hemodynamic stability, ensuring
ample intravenous access, assessing blood loss, initiating blood product protocols, and ensuring
clear communication and coordination among healthcare team members. Resuscitation typically
occurs in an operating room, allowing for comprehensive care, including anesthesia assistance
for complex interventions.

Objectives:

Differentiate the etiologies of postpartum hemorrhage based on patient history and

physical exam.

Identify the clinical features of postpartum hemorrhage, primarily focusing on blood loss.

Apply resuscitative strategies to manage postpartum hemorrhage in pregnant individuals.

Implement interprofessional team strategies to improve care coordination and

communication, improving outcomes in patients with postpartum hemorrhage.

Access free multiple choice questions on this topic.

Introduction
Postpartum hemorrhage (PPH) poses a significant risk to maternal health and is characterized by
excessive blood loss after delivery. While uterine contractions and the coagulation cascade
primarily regulate blood loss, PPH can lead to severe complications if untreated. Based on blood
loss thresholds, the traditional definition of PPH has evolved to encompass broader criteria
reflecting signs of hypovolemia. Traditionally, PPH is defined as more than 500 mL of estimated
blood loss in a vaginal delivery or more than 1000 mL of estimated blood loss during Cesarean
delivery. These parameters were redefined in 2017 by the American College of Obstetrics and
Gynecology as a cumulative blood loss of more than 1000 mL with signs and symptoms of
hypovolemia within 24 hours of the birth process, regardless of the mode of delivery. Though
this change was made with the knowledge that blood loss at the time of delivery is routinely
underestimated, more than 500 mL of blood loss at the time of vaginal delivery should be
considered abnormal with the potential need for intervention.[1][2][3]

PPH is frequently subdivided based on symptom onset. Primary PPH is hemorrhage that occurs
between the third stage of labor (ie, delivery of the placenta) and 24 hours after fetal delivery;
secondary PPH occurs more than 24 hours after delivery—up to 12 weeks postpartum. Causes,
summarized by the 4 "T's" (tone, trauma, tissue, thrombin), require prompt intervention.
Management involves a multidisciplinary approach, emphasizing blood loss assessment, fluid
replacement, and source control. Despite advancements, PPH prevention and prediction remain
essential to maternal well-being. PPH poses a significant challenge in obstetrics, complicated by
difficulties in accurately estimating blood loss, as cognitive biases can lead to delays in diagnosis
and management. Though more accurate, quantitative blood loss measurement methods have not
consistently improved clinical outcomes. Interprofessional approaches, including PPH bundles
and perinatal quality collaboratives, reduce morbidity. Management involves a coordinated effort
addressing uterine atony, genital tract lacerations, retained placental tissue, and coagulopathy,
with surgical interventions like hysterectomy as a last resort. Prevention strategies include active
management of the third stage of labor and prenatal identification of high-risk factors. Vigilance
and prompt intervention remain crucial in mitigating maternal morbidity and mortality associated
with PPH.[4][5]

Etiology
The primary causes of PPH are the 4 “T’s”: tone (uterine atony), trauma (lacerations or uterine
rupture), tissue (retained placenta or clots), and thrombin (coagulation deficiency). Uterine atony
is the most common cause of PPH, accounting for approximately 70% of cases. A vast array of
risk factors are associated with PPH, including advanced maternal age, nulliparity, and grand
multiparty. However, most risk factors are related to underlying causes.[6][7][8][9]

Secondary PPH is associated with retained placentas, subinvolution of placental sites, inherited
coagulopathies, and infectious etiologies. The following risk factors are associated with the 4
main etiologies:

Uterine atony: Chorioamnionitis, magnesium sulfate therapy, prolonged labor or

precipitous delivery, labor induction or augmentation, uterine fibroids, uterine inversion, or
conditions resulting in uterine overdistention (eg, multiple gestation, fetal macrosomia, or
polyhydramnios)

Trauma: Cesarean delivery, instrument-assisted vaginal birth, midline episiotomy,

precipitous delivery, and persistent occiput posterior position

Tissue: Prior Cesarean birth, placenta accreta, placental abruption and associated
hypertension, and uterine anomalies

Coagulopathy: Severe preeclampsia and eclampsia, HELLP (hemolysis, elevated liver-

enzyme level, and low platelet count) syndrome, intrauterine fetal death, placental
abruption, amniotic fluid embolism, or inherited coagulopathies (eg, von Willebrand
disease) [4][5][10][11]

Epidemiology
PPH occurs in approximately 1% to 3% of all deliveries and is the leading cause of obstetric
morbidity and mortality worldwide,[12] accounting for approximately 8% of maternal deaths in
developing countries and 20% of maternal deaths in developed countries. The United States has
one of the highest maternal mortality rates at 11% and continues to rise, increasing from 8 to 40
cases per 10,000 deliveries.[5] In Europe, PPH occurs in approximately 13% of deliveries.
Uterine atony, the primary cause of PPH, accounts for 70% to 80% of all hemorrhages.[13]
Pathophysiology
Physiologic changes during pregnancy, including an increase in uterine blood flow from
approximately 100 mL/min in a nonpregnant uterus to 700 mL/min, coagulation changes
resulting in a hypercoagulable state, and postpartum changes (eg, myometrial contraction and
local decidual hemostatic factors) cause significant bleeding. Therefore, conditions that lead to a
failure of these mechanisms can result in PPH. A loss of an approximate total blood volume of
more than 1500 mL will typically cause clinical features of hypovolemia.[5]

History and Physical

Postpartum Hemorrhage Clinical Evaluation

An accurate clinical assessment of blood loss volume and evaluation of the underlying etiology
is essential for promptly diagnosing PPH and initiating effective interventions. Initial patient
evaluation should include a rapid clinical assessment and review of the patient's risk factors.
Clinical features of significant blood loss, including tachycardia, tachypnea, and hypotension,
may be masked initially, as pregnant women can have a blood loss of more than 1000 mL before
signs of hypovolemia are apparent. Clinicians should remember that more than 25% of blood
volume, or approximately 1500 mL or more, is likely lost when signs of hypovolemia are
present. Prompt PPH recognition is difficult due to this delay in clinical features of hypovolemia.
Continued assessment during delivery and postpartum is recommended, including visual
estimation, weighing surgical sponges and drapes, and serial vital signs.[5][14] Serial vital signs
should include heart rate, blood pressure recordings every 15 min, respiratory rate, and
peripheral oxygen saturation. During PPH evaluation, clinicians should also be aware of
cognitive biases affecting their ability to diagnose PPH quickly. These biases include implicit
biases, which are unconscious stereotypes that affect a clinician's response to or treatment of
certain patients (eg, unconscious discrimination). Normalcy bias can cause clinicians to dismiss
signs and symptoms of hypovolemia as normal or temporary (eg, anxiety). Anchoring biases are
when clinicians only consider the first suspected diagnosis.

Examining the patient during the hemorrhage can help identify the probable cause of bleeding
focused on any specific risk factors. A rapid assessment of the entire lower genital tract,
including vaginal walls, cervix, and labia, for lacerations, hematomas, or signs of uterine rupture
(eg, regression of fetal presenting part and maternal abdominal tenderness), should be performed.
[15][16] The placenta should be examined to determine if the tissue remains intact, and a manual
examination with extraction should be performed for any retained placental tissue; a bedside
ultrasound assessment may be a part of the evaluation.[17]

A soft, "boggy" or noncontracted uterus is the common finding with uterine atony. Uterine
inversion presents as a round bulge or mass with palpation of the fundal wall in the cervix or
lower uterine segment, resulting from excessive umbilical cord traction or abnormally adherent
placenta. Widespread bleeding, including from venipuncture sites, is a sign of disseminated
intravascular coagulation. Patients may also present with acute vaginal bleeding peri- or
postpartum. The patient may also have an increased heart rate, respiratory rate, and dizziness. As
the patient loses blood, they may feel cold, have decreased blood pressure, and syncopal
episodes. Patients may also have signs and symptoms of shock (eg, confusion, blurry vision,
clammy skin, and weakness).[4][5]

Blood Loss Quantification

Several studies have established that PPH blood loss totals are typically clinically
underestimated, resulting in a misdiagnosis of excessive bleeding and, therefore, delayed
interventions. Quantitative blood loss methods have been recommended for more accurate
calculations, including graduated under-buttock drapes, laparotomy pads, sponge weighing,
artificial intelligence-enabled technology, and irrigation canisters. These methods are more
helpful than previous strategies involving awaiting hemoglobin changes and are meant to assist
in the early recognition of PPH. However, clinical outcomes have not improved because
clinicians may prioritize numeral parameters over the broad clinical picture. As such, waiting to
begin PPH protocols until a specific blood loss threshold is met could lead to less favorable
outcomes. Any amount of obstetric bleeding with clinical features of hypovolemia or a blood
loss of more than 500 mL should precipitate PPH assessment and consideration of interventional
protocols. Blood loss quantification should involve an interprofessional team of healthcare
professionals, including physicians, nurses, and technicians, to ensure accurate estimations when
active bleeding continues.[14][18]

Evaluation
Laboratory studies are included as part of PPH protocols to help assess the degree of blood loss
and guide interventions. PPH laboratory panels typically include complete blood count with
platelet count, partial thromboplastin time, plasma thromboplastin, fibrinogen, comprehensive
metabolic panel, ionized calcium, pH, and blood gases in addition to the routine prenatal
laboratory studies that are obtained on admission (eg, blood type and antibody screening).
[19] However, some interventions should not be withheld pending the results of these studies.
Complete blood count to assess hemoglobin, hematocrit, and platelets can be evaluated at
intervals, although lab values lag behind the clinical presentation. Coagulation studies and
fibrinogen are useful in patients with suspected disseminated intravascular coagulation,
including patients with secondary PPH, placental abruption, or preeclampsia. An indwelling
bladder catheter may monitor the patient's fluid status and assess urine output.[5][10]

Treatment / Management
General Postpartum Hemorrhage Management

The approach to treating PPH is focused on the patient's resuscitation when identifying and
treating the underlying cause. Maintaining the patient's hemodynamic stability ensures continued
perfusion to vital organs. As soon as PPH is identified, 2 large bore peripheral intravenous (IV)
catheters (14- or 16G) should be placed, and maternal blood type and antibody screen should be
confirmed in anticipation of aggressive corrective measures. Direct assessment of cumulative
blood loss is essential, and a focus on early initiation of protocols for releasing blood products
and massive transfusion protocols is necessary. Crystalloid and colloid IV fluids should be
administered as indicated, and clinicians should also evaluate patients to identify the underlying
cause and tailor treatments.[20]

Uterine Atony Management

Uterine atony is the most common cause of PPH; therefore, clinicians should assess patients for
this etiology. A soft uterus without physiologic contraction following delivery indicates uterine
atony. Removal of clots and bimanual massage should be performed as the first step to mitigate
excessive uterine bleeding. Medical management with uterotonic agents is typically the initial
pharmacologic intervention if uterine atony is identified. While oxytocin is recommended
routinely at delivery, additional uterotonic medications are necessary in up to 25% of patients
with PPH. Furthermore, the use of multiple uterotonic agents can have a synergistic effect.

Pharmacologic agents used in PPH management include:

Oxytocin: The International Federation of Gynecology and Obstetrics recommends giving

oxytocin 10 international units (IU) IV or intramuscularly (IM) first-line for uterine atony
if not administered prophylactically. The oxytocin hormone is naturally produced by the
posterior pituitary and works rapidly, with an onset of action within 1 to 6 minutes, to
cause uterine contraction following IV administration. Oxytocin has minimal adverse
events and may be given during bimanual massage in response to hemorrhage.
 Methylergonovine: Ergot alkaloids (eg, ergometrine, ergonovine, and
methylergonovine) are serotonergic receptor agonists and partial α-adrenergic receptor
agonists that cause sustained uterine contractions. The onset of action is approximately 1
to 3 minutes. Methylergonovine 200 µg IM or IV is typically recommended but is
relatively contraindicated in patients with hypertension.

Carboprost: As a 15-methyl prostaglandin F2-α analog, carboprost acts on prostaglandin

receptors to stimulate uterine contractions. The recommended dosage is 250 µg IM or
intramyometrially every 15 to 90 minutes for a maximum of 8 doses, with peak serum
concentrations reached in approximately 15 minutes. Carboprost is contraindicated in
severe hepatic, renal, and cardiovascular disease and may cause bronchospasm in patients
with asthma.

Misoprostol: Misoprostol is a prostaglandin E1 analog with a more prolonged onset of

action than other uterotonics, depending on the administration route, which includes oral,
sublingual, rectal, or buccal routes. The analog should be avoided in patients with
anticoagulant therapy or cardiovascular disease; adverse effects may include nausea,
diarrhea, and fever.

Tranexamic acid: Tranexamic acid (TXA) is not uterotonic but inhibits fibrinolysis and is
frequently used with uterotonic medications. The recommended dosage is 1 g of
tranexamic acid IV over 10 minutes within 3 hours of delivery after a PPH
diagnosis. TXA's onset of action is typically 5 minutes and is contraindicated in patients
with a history of hypercoagulopathy.[10]

If bimanual massage and uterotonic medications are insufficient to control hemorrhage, uterine
tamponade may be considered. An intrauterine balloon tamponade system can be used, typically
by filling an intrauterine balloon with 250 to 500 mL of normal saline. Uterine tamponade may
be useful in those with lower uterine segment atony, where uterotonic agents may have a delayed
onset of action. If an intrauterine balloon is not readily available, the uterus may be packed with
gauze, or multiple large Foley catheters may be placed concurrently. An accurate count of what
is placed in the uterus is critical to prevent retained foreign bodies. Compression sutures with a
rapidly absorbing suture (eg, chromic) may also be considered, as they are effective in 90% of
cases, according to current literature on protocols for PPH. Complications include uterine
necrosis and intrauterine synechiae. Compression sutures may affect future pregnancies, though
the incidence of successful pregnancy after uterine compression sutures ranges from 11% to
75%.[17][21]

Obstetrical Trauma

Rapid identification of the cause of PPH and the initiation of treatment should be simultaneous,
including identifying genital lacerations. If lacerations are identified as the source of bleeding,
they should be repaired quickly and bleeding should be reassessed. Transfer to an operating suite
with anesthesia assistance may be indicated if uterine artery laceration is suspected. Genital tract
hematomas may be suggested by clinical deterioration in the absence of other findings or genital
pressure. Management of rapidly expanding hematomas includes packing, arterial embolization,
or suturing. Routine antibiotic prophylaxis is not recommended. See StatPearls' companion
references, "Perineal Lacerations" and "Lower Genitourinary Trauma," for more information.

Uterine Inversion

Uterine inversion, when the uterus protrudes through the introitus following delivery, is
characterized by hypotension disproportionate to the amount of bleeding. Uterine inversion
typically appears as a blue-gray mass protruding from the vagina. Immediate manual
replacement of the uterus with the placenta in place (if not already detached) should be
performed by pushing the protruding fundus with a steady pressure back through the vagina into
the pelvis. However, if the uterus cannot be replaced, tocolytic agents (eg, nitroglycerin,
terbutaline, magnesium sulfate, or halothane) should be administered to relax the uterus and
cervix. If the uterus is still unable to be replaced, a laparotomy is performed, and the uterus can
be replaced by gentle upward traction; the cervical ring may have to be incised to allow uterine
replacement. Following uterine replacement, uterotonics should be administered to facilitate
uterine contraction and control bleeding.

Retained Placenta

In patients with placenta accreta, a planned Cesarean delivery, with or without hysterectomy, is
typically performed between 34 and 37 weeks gestation. Due to the complexity of the procedure,
Cesarean hysterectomy involves interprofessional collaboration. Additionally, the ureters may be
stented before the procedure to avoid injury. In patients suspected to have retained products of
conception, manual intrauterine exploration or uterine ultrasonography is typically sufficient to
diagnose retained products of conception (eg, succenturiate lobe). An ultrasound finding of an
echogenic mass within the endometrial cavity immediately after delivery is consistent with a
retained placenta. For patients who have findings consistent with retained products of
conception, manual removal or banjo curette, with or without ultrasound guidance, is performed.
If the placenta is unable to be manually detached, the patient should be counseled on retained
placenta complications and potential hysterectomy while being transferred to an operating
room. See StatPearls' companion reference, "Placenta Accreta," for more information.

Coagulopathy

In patients with placental abruption or amniotic fluid embolus resulting in PPH, acute
coagulopathy should be considered, as these conditions frequently cause a consumptive
coagulopathy. Coagulopathies should also be considered in patients with secondary PPH. Blood
transfusion and fluid replacement are required for most PPH caused by
coagulopathies. Obstetrical transfusion protocols comprising packed red blood cells (RBCs),
fresh-frozen plasma, and platelets in various ratios are utilized to correct coagulation deficits and
maintain the hemoglobin level at more than 7 to 8 g/dL, the fibrinogen level greater than 2 g/L,
and the platelet count at 50,000 to 75,000 µL.[10]

Additional Postpartum Hemorrhage Management Strategies

In patients with continued PPH due to any etiology unresponsive to initial interventions, other
management options include hypogastric artery ligation, uterine artery embolization, and
hysterectomy. Uterine artery embolization may be considered in a patient who is stable with
persistent bleeding. Fluoroscopy is used to identify and occlude bleeding vessels. While those
who are unstable are not a candidate for this modality, benefits include uterine conservation
and preservation of fertility. However, studies have demonstrated that patients who have
undergone uterine artery embolization have an increased risk of infertility, preterm delivery, and
intrauterine growth restriction.

Exploratory laparotomy is typically indicated in the setting where less invasive measures for
postpartum hemorrhage have failed or if the suspected reason for postpartum hemorrhage (eg,
morbidly adherent placenta) is elucidated. A midline vertical abdominal incision should be
considered to maximize exposure; however, the existing incision may be used if the patient had a
Cesarean delivery. Vascular ligation sutures may be attempted to decrease pulse pressure in the
uterus. Bilateral uterine artery ligation (O'Leary sutures) or bilateral utero-ovarian ligament
ligation sutures may be placed. Hypogastric artery ligation can also be performed; however, as
this procedure entails a retroperitoneal approach, the approach is rarely used. The definitive
treatment for postpartum hemorrhage is a hysterectomy. A peripartum hysterectomy is associated
not only with permanent sterility but also an increased surgical risk with a higher risk of bladder
and ureteral injury. Supracervical hysterectomy may be performed alternately as a faster surgery
with potentially fewer complicated risks.[5]
Hemodynamic Management

Implementing an effective blood transfusion protocol when the underlying etiology is being
assessed and treated is critical to patient resuscitation and achieving hemodynamic stability.
Severe hemorrhage leads to acidosis, hypothermia, and coagulopathy, which must be quickly
corrected to avoid the risk of mortality. Therefore, other patient status indicators, including heart
rate, respirations, peripheral oxygen saturation, temperature, and blood gases, should be
monitored in addition to blood pressure. In patients with severe PPH, a massive transfusion
protocol must frequently be initiated, which is standard in most institutions. Massive transfusion
is defined as a transfusion of more than 10 units of packed RBCs within 24 hours or 4 RBC units
in 1 hour with additional units anticipated. Most massive transfusion protocols recommend a
combination of packed RBCs, fresh-frozen plasma, platelets, and cryoprecipitate in fixed ratios.
The most common ratio utilized is 1:1:1 (1 unit of packed RBCs, 1 unit of fresh-frozen plasma,
and 1 unit of platelets); other recommended protocols include 6:4:1 and 4:4:1.

Lactate and electrolyte levels must be monitored throughout the transfusion to determine
adequate vascular perfusion and correct metabolic abnormalities. Hyperkalemia, hypocalcemia,
and hypomagnesemia commonly occur secondary to massive transfusion, and lactic acidosis
indicates persistent tissue hypoperfusion. Complications associated with massive transfusions
include transfusion-related lung injury, pulmonary edema, transfusion-associated circulatory
overload, and blood transfusion reactions. Other adjunct strategies that may be considered
include cell salvage (ie, autologous blood transfusion), sometimes used in patients at high risk
for PPH (eg, known placenta accreta), recombinant activated factor VII, and vasopressors (eg,
phenylephrine or norepinephrine).[15] See StatPearls' companion reference, "Massive
Transfusion," for more information. Clinicians should discuss the need for blood transfusion with
all patients who are pregnant during their prenatal visits and upon hospital admission to guide
hemodynamic management, particularly in patients refusing blood products (eg, Jehovah
Witnesses). Following patient stabilization, decisions for additional transfusions should be based
on clinical symptoms and laboratory studies.[10][22]

Differential Diagnosis
The differential diagnosis for the causes of early PPH include:

Uterine atony

Lacerations

Uterine inversion

Retained placenta

Uterine rupture

Coagulopathy

Endometritis

Chorioamnionitis

Prognosis
Post-partum hemorrhage is a leading cause of maternal and fetal morbidity in the United States;
however, correct and timely institution of treatment can vastly improve patient outcomes.
Patients who had PPH in a previous delivery are at risk of having PPH in subsequent deliveries.
Implementation of standardized PPH protocols and interprofessional simulation training has
helped improve patient outcomes. Additionally, increased efforts to enhance coordination among
healthcare team members in response to PPH have contributed to reduced maternal morbidity.
[10]

Complications
Blood loss occurs in PPH, putting the patient at risk of hypovolemic shock. When patients lose
20% of blood, they develop tachycardia, tachypnea, narrowed pulse pressure, and delayed
capillary refill. This may lead to ischemic injury to the liver, brain, heart, and kidneys. Sheehan
syndrome, or postpartum hypopituitarism, is also a complication of excessive blood loss seen in
postpartum hemorrhage.

Complications related to PPH management include the following:

Transfusion-related acute lung injury

Infection

Pulmonary edema

Hemolytic transfusion reactions

Intrauterine synechiae

Preterm delivery

Infertility

Consultations
An interprofessional approach is mandatory for the required outcomes in the management of
PPH, including:

Obstetrics and gynecology

Maternal-fetal medicine

General surgery

Anesthesiology

Hematology

Urology

Emergency medicine

Laboratory personnel

Interventional radiology

Deterrence and Patient Education

The recommended strategy to manage PPH is preventing hemorrhage from beginning or
worsening. The International Federation of Gynecology and Obstetrics recommends the
following anticipatory interventions to avoid PPH in all deliveries:

Oxytocin 10 IU IV/IM for all vaginal and Cesarean deliveries during or after placental
delivery. If oxytocin is unavailable, other uterotonics (eg, ergometrine or
methylergometrine) may be used if not contraindicated.

Early uterine tone assessment immediately following delivery in all women to identify
uterine atony.
 Trained clinicians may employ controlled cord traction during placental delivery to reduce
blood loss; if skilled birth attendants are unavailable, controlled cord traction is not
recommended due to the risk of uterine inversion.

In women who have received prophylactic oxytocin, sustained uterine massage is not
recommended to prevent PPH.

Identifying patients who are high-risk before delivery is an important factor in preventing
morbidity and mortality associated with PPH. Early identification of such patients allows
preemptive planning, including delivery mode, timing, specialist consultation, and delivery
setting. Patients with previous Cesarean delivery should have an ultrasound evaluation
antepartum to assess for signs of abnormal placental implantation and determine the appropriate
route and place of delivery. Treating patients with anemia by oral or parenteral iron
supplementation should be considered, especially in patients with hematocrit levels below 30%.
Additionally, consideration for erythropoietin-stimulating agents with hematology consultation
should be undertaken with patients at high risk, especially if they do not accept blood
transfusions.

Standardized, interprofessional protocols help decrease severe maternal morbidity associated

with postpartum hemorrhage. These protocols focus on unit readiness, recognition and
prevention, response, and reporting systems. The nursing and anesthesia teams should be aware
of the postpartum hemorrhage to assist. Simulation activities can be utilized in event training in
PPH and have improved outcomes.[17][21]

Enhancing Healthcare Team Outcomes

PPH necessitates a cohesive interprofessional team comprising physicians, technicians, nurses,
pharmacists, laboratory personnel, and labor and delivery nurses. The primary focus is prompt
resuscitation while pinpointing and addressing the underlying cause, often surgical. Maintaining
patient hemodynamic stability is paramount for organ perfusion. The team ensures ample
intravenous access and employs direct blood loss assessment, initiating protocols for blood
products and massive transfusions. Simultaneously, rapid identification of the cause and
treatment initiation occurs. Throughout this process, clear communication between team
members and care coordination is critical to prevent missed diagnoses and delays in intervention.
Resuscitation ideally unfolds in an operating department setting, allowing anesthesia assistance
for complex laceration repairs, uterine inversion correction, analgesia provision, or surgical
exploration if needed. Effective communication, clear delineation of responsibilities, and
coordinated efforts among team members optimize patient-centered care, enhance outcomes,
ensure patient safety, and elevate team performance in managing PPH.

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Disclosure: Kelly Wormer declares no relevant financial relationships with ineligible companies.

Disclosure: Radia Jamil declares no relevant financial relationships with ineligible companies.

Disclosure: Suzanne Bryant declares no relevant financial relationships with ineligible companies.

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