Last updated March 15, 2022

Postpartum Hemorrhage

Recommendations and Conclusions

The following recommendations and conclusions are based on good and consistent scientific evidence.

  • All obstetric care facilities should have guidelines for the routine administration of uterotonics in the immediate postpartum period.
  • Uterotonic agents should be the first-line treatment for postpartum hemorrhage caused by uterine atony. The specific agent selected, outside of recognized contraindications, is at the health care provider’s discretion because none has been shown to have greater efficacy than others for the treatment of uterine atony.
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574

The following recommendations and conclusions are based on limited or inconsistent scientific evidence.

When uterotonics fail to adequately control postpartum hemorrhage, prompt escalation to other interventions (such as tamponade or surgical tech- niques) and escalation of intensity of care and support personnel are indicated. Given the mortality reduction findings, tranexamic acid should be considered in the setting of obstetric hemorrhage when initial medical therapy fails. Obstetrician–gynecologists and other obstetric care providers should work with their institutions to ensure the existence of a designated multidisciplinary response team, a staged postpartum hemorrhage protocol that includes guidelines for escalation of care, and a functioning massive transfusion protocol.
574

The following recommendations and conclusions are based primarily on consensus and expert opinion.

  • Management of postpartum hemorrhage should use a multidisciplinary and multifaceted approach that involves maintaining hemodynamic stability while simultaneously identifying and treating the cause of blood loss.
  • Generally, in the treatment of postpartum hemorrhage, less invasive methods should be used initially if possible, but if unsuccessful, preservation of life may require more aggressive interventions including hysterectomy.
  • When a massive transfusion protocol is needed, fixed ratios of packed red blood cells, fresh frozen plasma, and platelets should be used.
  • Hospitals should consider adopting a system to implement key elements in four categories:
    • 1) readiness to respond to a maternal hemorrhage
    • 2) recognition and prevention measures in place for all patients
    • 3) a multidisciplinary response to excessive maternal bleeding and
    • 4) a systems-based quality improvement process to improve responsiveness through reporting and system learning.
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Recommendation Grading

Overview

Title

Postpartum Hemorrhage

Authoring Organization

Publication Month/Year

October 1, 2017

Document Type

Consensus

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Adolescent, Adult

Health Care Settings

Ambulatory, Emergency care, Hospital

Intended Users

Physician, nurse midwife, nurse, nurse practitioner, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D006470 - Hemorrhage, D006473 - Postpartum Hemorrhage

Keywords

maternal hemorrhage, postpartum hemorrhage, hypovolemia