Postpartum hemorrhage: A review of evidence based guidelines for prevention and management
Author(s): Swetha Lakshmi Allu, Rekha N, Hema HR, Dwarakanath L and Rajanna SP
Abstract: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide, nearly one-quarter of all maternal deaths, necessitating prompt and effective management strategies. The overall prevalence of PPH worldwide is estimated to be 6 to 11 percent. This review provides a comprehensive overview of the current approaches to PPH management. The etiology of PPH is categorized into the "4 Ts": tone, trauma, tissue, and thrombin, which guide diagnosis and intervention. The initial approach to managing PPH involves recognizing the condition, identifying its cause, and initiating suitable interventions tailored to the underlying etiology. Treatment typically follows a stepwise progression from minimally invasive methods to more invasive options, including compression techniques, pharmacologic agents, procedural interventions, and surgical treatments. For refractory cases, second-line interventions include balloon tamponade, uterine compression sutures, and arterial embolization. In life-threatening situations, surgical options such as internal iliac artery ligation or peripartum hysterectomy are employed to achieve definitive hemostasis. While these techniques are life-saving, they require specialized expertise and resources, underscoring the need for well-equipped healthcare systems and trained personnel. Preventive strategies, including active management of the third stage of labour and risk stratification, play a pivotal role in reducing PPH incidence. This review also highlights disparities in PPH outcomes globally, particularly in low-resource settings, and the importance of strengthening healthcare systems and ensuring access to life-saving interventions. By synthesizing the latest evidence, this review aims to provide clinicians and policymakers with a comprehensive resource for improving maternal outcomes in the management of postpartum hemorrhage.
Pages: 18-25 | 738 Views | 426 Downloads
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