Postpartum hemorrhage
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2]
Synonyms and keywords:
Overview
Historical Perspective
- In 1953, du Vigneaud et al. and Tuppy were the first to discover the aminoacid sequence of oxytocin and its biochemical synthesis.[1]
- In 1962, the use of prophylactic uterotonic agent, early cord clamping, and controlled cord traction were defined by Spencer for the active management of the third stage of labor (AMTSL).[2]
- The reduction of postpartum hemorrhage by the active management of the third stage of labor (AMTSL) compared to the physiological (expectant) management was established by Prendiville et al. in 1988 following a randomized controlled trial.[3]
- In 1997, the B-Lynch surgical technique was developed by B-Lynch et al. to treat postpartum hemorrhage.[4]
- In 2005, first placebo-controlled study of misoprostol was conducted by Derman et al. for the prevention of postpartum hemorrhage.[5]
- In 2007, the use of misoprostol in the absence of oxytocin was recommended by World Health Organization (WHO) for the prevention of postpartum hemorrhage.[1]
Classification
Postpartum hemorrhage is classified according to the duration between the delivery and hemorrhage into 2 groups: primary and secondary.[6]
- If the postpartum hemorrhage begins within the first 24 hours after birth, it is classified as primary postpartum hemorrhage.
- If the postpartum hemorrhage occurs between 24 hours and 12 weeks after birth, it is classified as secondary postpartum hemorrhage.
Pathophysiology
The pathophysiology of postpartum hemorrhage depends on the underlying etiology:
- Inadequate contractions following the delivery (uterine atony)[7]
- Trauma in either vulva, vagina, or cervix during the delivery (obstetrical lacerations)[8]
- Placenta accreta, increta, percreta, or incomplete delivery of placenta (retained placental tissue)[6]
- Massive activation of the coagulation system and subsequent consumption of the coagulation factors (disseminated intravascular coagulation), platelet disorders (thrombocytopenia caused by preeclampsia, HELLP, ITP, TTP, acute fatty liver of pregnancy and HUS, and also qualitative platelet disorders), von Willebrand disease (vWD), hemophilia A, and hemophilia B (maternal coagulation disorders) [9]
Causes
The most common cause of postpartum hemorrhage is uterine atony. Less common causes of postpartum hemorrhage include obstetrical lacerations, retained placental tissue, and clotting factor deficiencies.[6]
Differentiating ((Page name)) from other Diseases
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Epidemiology and Demographics
The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.
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In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
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In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.
Patients of all age groups may develop [disease name].
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The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.
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[Disease name] commonly affects individuals younger than/older than [number of years] years of age.
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[Chronic disease name] is usually first diagnosed among [age group].
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[Acute disease name] commonly affects [age group].
There is no racial predilection to [disease name].
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[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].
[Disease name] affects men and women equally.
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[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.
The majority of [disease name] cases are reported in [geographical region].
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[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].
Risk Factors
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The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].
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Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
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Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.
Screening
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According to the [guideline name], screening for [disease name] is not recommended.
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According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].
Natural History, Complications, and Prognosis
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
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Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
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Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
Diagnosis
Diagnostic Study of Choice
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The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
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The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
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There are no established criteria for the diagnosis of [disease name].
History and Symptoms
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The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
Physical Examination
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
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Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
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The presence of [finding(s)] on physical examination is diagnostic of [disease name].
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The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
Laboratory Findings
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
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Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
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[Test] is usually normal among patients with [disease name].
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Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
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There are no diagnostic laboratory findings associated with [disease name].
Electrocardiogram
There are no ECG findings associated with [disease name].
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An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
X-ray
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An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
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There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
Echocardiography or Ultrasound
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Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
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There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
CT scan
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[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
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There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
MRI
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[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
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There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
Other Imaging Findings
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[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
Other Diagnostic Studies
There are no other diagnostic studies associated with [disease name].
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[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
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Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].
Treatment
Medical Therapy
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
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Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
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The majority of cases of [disease name] are self-limited and require only supportive care.
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[Disease name] is a medical emergency and requires prompt treatment.
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The mainstay of treatment for [disease name] is [therapy].
OR The optimal therapy for [malignancy name] depends on the stage at diagnosis.
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[Therapy] is recommended among all patients who develop [disease name].
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Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
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Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
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Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
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Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
Surgery
Surgical intervention is not recommended for the management of [disease name].
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Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
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The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
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The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
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Surgery is the mainstay of treatment for [disease or malignancy].
Primary Prevention
There are no established measures for the primary prevention of [disease name].
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There are no available vaccines against [disease name].
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Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
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[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].
Secondary Prevention
There are no established measures for the secondary prevention of [disease name].
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Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].
References
- ↑ 1.0 1.1 Prata N, Bell S, Weidert K (2013). "Prevention of postpartum hemorrhage in low-resource settings: current perspectives". Int J Womens Health. 5: 737–52. doi:10.2147/IJWH.S51661. PMC 3833941. PMID 24259988.
- ↑ Hofmeyr GJ, Mshweshwe NT, Gülmezoglu AM (January 2015). "Controlled cord traction for the third stage of labor". Cochrane Database Syst Rev. 1: CD008020. doi:10.1002/14651858.CD008020.pub2. PMC 6464177. PMID 25631379.
- ↑ Prendiville WJ, Harding JE, Elbourne DR, Stirrat GM (November 1988). "The Bristol third stage trial: active versus physiological management of third stage of labour". BMJ. 297 (6659): 1295–300. doi:10.1136/bmj.297.6659.1295. PMC 1834913. PMID 3144366.
- ↑ El-Hamamy E, Wright A, B-Lynch C (May 2009). "The B-Lynch suture technique for postpartum haemorrhage: a decade of experience and outcome". J Obstet Gynaecol. 29 (4): 278–83. doi:10.1080/01443610902797645. PMID 19835492.
- ↑ Derman RJ, Kodkany BS, Goudar SS, Geller SE, Naik VA, Bellad MB, Patted SS, Patel A, Edlavitch SA, Hartwell T, Chakraborty H, Moss N (October 2006). "Oral misoprostol in preventing postpartum haemorrhage in resource-poor communities: a randomised controlled trial". Lancet. 368 (9543): 1248–53. doi:10.1016/S0140-6736(06)69522-6. PMID 17027730.
- ↑ 6.0 6.1 6.2 Bienstock JL, Eke AC, Hueppchen NA (2021). "Postpartum Hemorrhage". N Engl J Med. 384 (17): 1635–1645. doi:10.1056/NEJMra1513247. PMID 33913640 Check
|pmid=value (help). - ↑ Breathnach F, Geary M (2009). "Uterine atony: definition, prevention, nonsurgical management, and uterine tamponade". Semin Perinatol. 33 (2): 82–7. doi:10.1053/j.semperi.2008.12.001. PMID 19324236.
- ↑ "ACOG Practice Bulletin No. 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery". Obstet Gynecol. 132 (3): e87–e102. September 2018. doi:10.1097/AOG.0000000000002841. PMID 30134424.
- ↑ Silver RM, Major H (March 2010). "Maternal coagulation disorders and postpartum hemorrhage". Clin Obstet Gynecol. 53 (1): 252–64. doi:10.1097/GRF.0b013e3181cef930. PMID 20142661.