How is coagulopathy-related postpartum hemorrhage (PPH) treated?

Updated: Jun 27, 2018
  • Author: John R Smith, MD, FACOG, FRCSC; Chief Editor: Ronald M Ramus, MD  more...
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Answer

If manual exploration has excluded uterine rupture or retained placental fragments, bleeding from a well-contracted uterus is most commonly due to a defect in hemostasis. A review of the history and risk factors along with coagulation test results clarifies this diagnosis. Proceed with blood product replacement as previously described in order to correct abnormalities of hemostasis. If the coagulation status is normal and bleeding is ongoing despite a well-contracted uterus, then the possibilities of uterine rupture or an inadequately repaired uterine incision (if the patient had a cesarean delivery) must be considered. Revisit any repair to the cervix or vagina before proceeding to surgical management.


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