Postpartum Hemorrhage Management

Diagnosis and Assessment

The American College of Obstetricians and Gynecologists recommends evaluating patients with postpartum hemorrhage for signs of hypovolemia, such as tachycardia and hypotension, and assessing uterine size and tone 1
Patients with postpartum hemorrhage should have their coagulation parameters evaluated, including platelet count, prothrombin time, partial thromboplastin time, and fibrinogen levels 1
Fibrinogen levels <200 mg/dL are associated with severe postpartum hemorrhage 1
Platelet count should be maintained above 50,000/mm³ 2

The American College of Obstetricians and Gynecologists recommends administering uterotonic agents, such as oxytocin, ergot derivatives, and prostaglandins, to maintain uterine contraction and prevent new clot formation 1
In cases of severe hemorrhage, early hemostatic resuscitation with red blood cells, fresh frozen plasma, and platelets in a 1:1:1 ratio should be initiated 2, 3
Transfusion should not be delayed pending laboratory results 1

If bleeding persists after clot evacuation, uterine tamponade with a balloon or packing should be considered 1
Embolization of uterine arteries via interventional radiology may be considered 1
Ligation of hypogastric arteries may be considered, although its efficacy is not fully proven 1
Pelvic packing may be considered in cases of uncontrolled hemorrhage 1
Hysterectomy may be considered as a last resort 1

Maintaining body temperature above 36°C is essential, as hypothermia negatively affects coagulation factor function 1, 3
Acidosis should be corrected to maintain acid-base balance 1
Antibiotics should be re-dosed if blood loss exceeds 1500 ml 1
Postoperative monitoring in an intensive care unit is recommended for patients with severe hemorrhage 1

Early manual evacuation of clots reduces the need for surgical interventions 1
Fibrinogen level is the most predictive biomarker of severe postpartum hemorrhage 1
A stepped approach to management, starting with conservative measures and advancing as needed, is recommended 1
Frequent communication between the surgical team and postoperative care team is essential 1