Postpartum vs peripartum haemorrhage

• Antepartum (affects 2−5% of all pregnancies)1
  • Placenta previa
  • Placental abruption
  • Trauma
  • Rupture of the uterus
• Postpartum (complicates about 5% of all births)2
  • Uterine atony is responsible for the vast majority of postpartum haemorrhage (up to ~70%)3

1. Walfish M, et al. Br J Anaesth 2009;103:i47−56;


2. WHO PPH guidelines 2018. https://www.who.int/reproductivehealth/uterotonics-for-PPH-prevention-slidedoc.pptx?ua=1; 

3. Evensen A, et al. Am Fam Physician 2017;95:442−9

What is postpartum haemorrhage?

Postpartum haemorrhage vs. severe haemorrhage in pregnancy ?

Characteristics of life-threatening bleeding

1. Loss of a certain volume of blood per time unit, e.g.:1,2 
   1. Loss of whole blood volume within 24 hours (equivalent to about 10 erythrocyte transfusion units in an adult) or 
   2. Loss of 50% of blood volume within 3 hours, or 
   3. Ongoing blood loss in excess of 150 mL/min 
2. Blood loss at the site leading to a threat to vital functions (e.g. bleeding into the CNS)1 
3. Presence of clinical/laboratory signs of tissue hypoperfusion during bleeding2

CNS, central nervous system


1. JPAC Transfusion Handbook. https://www.transfusionguidelines.org/transfusion-handbook/7-effective-transfusion-in-surgery-and-critical-care/7-3-transfusion-management-of-major-haemorrhage
 
2. Kaur P, et al. J Emerg Trauma Shock 2011; 4:103−8

Factors determining the severity of bleeding1,2

• Rate and/or total amount of blood loss
• Primary cause/source of bleeding
• State of the coagulation system
• Number of units of blood products and/or blood derivatives
• Presence of clinical and/or laboratory signs of tissue hypoperfusion and/or signs of organ dysfunction

1. Pařízek A, et al. Čes Gynek 2018;83:150−7; 

2. Blatny J, Blaha J, et al. ANESTEZIOLOGIE A INTENZIVNI MEDICINA 2017;28(4):103−8