Advances in the Treatment of Postpartum Hemorrhage

Alison M El Ayadi; Nuriya Robinson; Stacie Geller; Suellen Miller


Expert Rev of Obstet Gynecol. 2013;8(6):525-537. 

In This Article

Expert Commentary

The evidence base around PPH prevention and treatment has rapidly expanded over the past decade. Randomized trials evaluating the effectiveness of TXA and fibrinogen concentrate are underway and should provide strengthened treatment guidance over the next few years. The field has benefited from focused efforts on the development of lower cost methods to improve blood loss estimation and temporizing measures targeted for use in low-resource settings such as anti-shock garments.

Hemorrhage preparedness through drills and standardized hemorrhage management guidelines are among the most promising measures for PPH. Algorithms for hypovolemic shock resuscitation have benefited from trauma research, and massive transfusion protocols are now being implemented on obstetric wards. These steps improve patient care and prevent severe anemia and coagulopathy. Broader implementation of higher FFP to RBC transfusion ratios (1:1 or 1:2) noted to improve patient outcomes in the trauma literature should optimize transfusion protocols for PPH in the near future.

While adequate therapeutic options are available for PPH in developed countries, reducing the global burden of PPH requires focused attention on prevention, early identification and access to care. However, delays in making the decision to seek medical care, reaching a facility where care is available and in obtaining quality care at the facility are all significant contributors to preventable maternal death in low-resource settings.