57. Postpartum hemorrhage

Blood loss ≥ 1000 mL or blood loss manifesting with features of hypovolemia within 24 hours of delivery.

• Primary PPH: blood loss ≤ 24 hours postpartum (more common)

• Secondary PPH: blood loss from 24 hours to 12 weeks postpartum

• Leading cause of maternal mortality worldwide

• Approx. 5% of obstetric patients experience PPH.

• PPH causes 12% of maternal deaths in the US.

• HELLP syndrome

• Sepsis

• Fetal death

• von Willebrand disease

• Hemophilia

• Platelet dysfunction disorders

• Coagulation factor deficiencies (e.g., factor XIII deficiency)

• Fever

• Sepsis

• Mucocutaneous bleeding (e.g., bruising, petechiae)

• GI bleeding, menorrhagia

• Based on clinical features and laboratory studies

• CBC, coagulation panel including PT, aPTT, fibrinogen, D-dimer and other FDPs

• vWF antigen, vWF activity

• Transfusion of blood products as needed (e.g., FFP, platelets)

• Replacement of specific coagulation factors (e.g. XI for hemophilia)

• Concentrates containing vWF and factor VIII (for vWD)

• Pharmacological therapy (e.g., desmopressin, antifibrinolytics)