Postpartum Hemorrhage Causes and Management

Primary Causes of PPH

Uterine atony is the most common cause of postpartum hemorrhage, responsible for more than 75% of all PPH cases, according to the American College of Radiology 1, 2
Trauma, including lacerations, rupture, and hematomas, represents the second most common category of PPH causes, as reported by the American College of Radiology 1, 2
Retained products of conception with or without infection are also a cause of PPH, as noted by the American College of Radiology 4, 5
Coagulopathy, including DIC, is listed among the less common causes of PPH, according to the American College of Radiology 4, 5

Standard coagulation tests, such as PT, PTT, fibrinogen, platelets, and D-dimer, must be interpreted in the context of pregnancy-specific reference ranges, as recommended by the Journal of Thrombosis and Haemostasis 6
A pregnancy-specific DIC score using fibrinogen, PT difference, and platelet count has 88% sensitivity and 96% specificity, although the source of this information is not cited in the provided text, it is related to 7
Fibrinogen levels less than 2 g/L occur in 17% of cases with blood loss exceeding 2000 mL, indicating evolving coagulopathy, as reported by Praxis Medical Insights 7

The American College of Radiology recommends immediate correction of coagulopathy with blood products, such as packed RBCs, fresh frozen plasma, platelets, and fibrinogen concentrate, when DIC complicates PPH, although the exact citation is not provided, it is related to 3, 8
Praxis Medical Insights advises against waiting for laboratory confirmation of DIC before initiating massive transfusion protocol when blood loss exceeds 1,500 mL, and recommends immediate blood product administration in fixed ratios while addressing the underlying cause 3, 7, 8