ABSTRACT: Maternal hemorrhage, defined as a cumulative blood loss of greater than or equal to 1,000 mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process, remains the leading cause of maternal mortality worldwide Lancet Glob Health</a> 2014;2: e323–33. (Systematic Review)">1. Additional important secondary sequelae from hemorrhage exist and include adult respiratory distress syndrome, shock, disseminated intravascular coagulation, acute renal failure, loss of fertility, and pituitary necrosis (Sheehan syndrome).
Hemorrhage that leads to blood transfusion is the leading cause of severe maternal morbidity in the United States closely followed by disseminated intravascular coagulation J Womens Health (Larchmt)</a> 2014;23: 3–9. (Level III)">2. In the United States, the rate of postpartum hemorrhage increased 26% between 1994 and 2006 primarily because of increased rates of atony Am J Obstet Gynecol</a> 2010;202: 353.e1–6. (Level II-3)">3. In contrast, maternal mortality from postpartum obstetric hemorrhage has decreased since the late 1980s and accounted for slightly more than 10% of maternal mortalities (approximately 1.7 deaths per 100,000 live births) in 2009 J Womens Health (Larchmt)</a> 2014;23: 3–9. (Level III)">2 Am J Obstet Gynecol</a> 2008;199: 133.e1–8. (Level II-3)">4. This observed decrease in mortality is associated with increasing rates of transfusion and peripartum hysterectomy J Womens Health (Larchmt)</a> 2014;23: 3–9. (Level III)">2 Am J Obstet Gynecol</a> 2010;202: 353.e1–6. (Level II-3)">3 Am J Obstet Gynecol</a> 2008;199: 133.e1–8. (Level II-3)">4.
The purpose of this Practice Bulletin is to discuss the risk factors for postpartum hemorrhage as well as its evaluation, prevention, and management. In addition, this document will encourage obstetrician–gynecologists and other obstetric care providers to play key roles in implementing standardized bundles of care (eg, policies, guidelines, and algorithms) for the management of postpartum hemorrhage.
