Cited by 1,406Maternal and fetal healthcareBlood transfusion and managementMaternal and Perinatal Health Interventions

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Practice Bulletin No. 183: Postpartum Hemorrhage

·2017·Obstetrics & Gynecology

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Abstract

Maternal hemorrhage, defined as a cumulative blood loss of greater than or equal to 1,000 mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process, remains the leading cause of maternal mortality worldwide (1). Additional important secondary sequelae from hemorrhage exist and include adult respiratory distress syndrome, shock, disseminated intravascular coagulation, acute renal failure, loss of fertility, and pituitary necrosis (Sheehan syndrome). Hemorrhage that leads to blood transfusion is the leading cause of severe maternal morbidity in the United States closely followed by disseminated intravascular coagulation (2). In the United States, the rate of postpartum hemorrhage increased 26% between 1994 and 2006 primarily because of increased rates of atony (3). In contrast, maternal mortality from postpartum obstetric hemorrhage has decreased since the late 1980s and accounted for slightly more than 10% of maternal mortalities (approximately 1.7 deaths per 100,000 live births) in 2009 (2, 4). This observed decrease in mortality is associated with increasing rates of transfusion and peripartum hysterectomy (2–4). The purpose of this Practice Bulletin is to discuss the risk factors for postpartum hemorrhage as well as its evaluation, prevention, and management. In addition, this document will encourage obstetrician–gynecologists and other obstetric care providers to play key roles in implementing standardized bundles of care (eg, policies, guidelines, and algorithms) for the management of postpartum hemorrhage.

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Venue: Obstetrics & Gynecology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2017-10
Volume: 130
Issue: 4
Pages: e168-e186
ISSN: 0029-7844 (ISSN-L)
DOI: 10.1097/aog.0000000000002351
OpenAlex: W2786382895
Semantic Scholar: 70dafd2c828372fe87567d6d264e7bb158f81531
Cited by: 1,406
References: 2,307
Citations by year: 2026: 152 · 2025: 174 · 2024: 151 · 2023: 163 · 2022: 152 · 2021: 174 · 2020: 138 · 2019: 106 · 2018: 77 · 2017: 52
FWCI: 111.31
Type: journal article
Language: en
Open access: closed
Locations: Obstetrics and Gynecology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
Health Sciences › Medicine › Hematology › Blood transfusion and management
Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
Keywords: postpartum hemorrhage, maternal mortality, risk factors, prevention, uterine atony, blood transfusion, peripartum hysterectomy, Sheehan's syndrome, disseminated intravascular coagulation, obstetric care
MeSH terms: Female, Postpartum Hemorrhage, Humans, Obstetrics, Pregnancy, Risk Factors, United States, Disease Management, Standard of Care, Maternal Death

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Practice Bulletin No. 183: Postpartum Hemorrhage

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