Define postpartum hermorrhage.
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
Describe the epidemiology.
Leading cause of maternal mortality worldwide
Approx. 5% of obstetric patients experience PPH.
PPH causes 12% of maternal deaths in the US.
What are acquired coagulation disorders causing postpartum hermorrhage?
HELLP syndrome
Sepsis
Fetal death
What are inherited coagulation disorders causing postpartum hermorrhage?
von Willebrand disease
Hemophilia
Platelet dysfunction disorders
Coagulation factor deficiencies (e.g., factor XIII deficiency)
What are clinical features of coagulation disorders causing postpartum hemorrhage?
Fever
Mucocutaneous bleeding (e.g., bruising, petechiae)
GI bleeding, menorrhagia
Describe the diagnostics.
Based on clinical features and laboratory studies
CBC, coagulation panel including PT, aPTT, fibrinogen, D-dimer and other FDPs
vWF antigen, vWF activity
Describe the management.
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)
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