title: Obstetric hemorrhage.
abstract: OBJECTIVE
  To provide a review of the current literature on the management of obstetric hemorrhage.
  
  
  RESULTS
  Obstetric hemorrhage remains a prominent cause of maternal morbidity and mortality. When postpartum hemorrhage is refractory to manual and pharmacologic treatments, escalating interventions may be needed. Second-line interventions include the use of intrauterine balloon (or gauze) tamponade and uterine compression sutures. If these therapies fail to stop the bleeding, patients may need to undergo radiological embolization, pelvic devascularization, or hysterectomy. In recent years, pelvic arterial embolization has become a common treatment for intractable postpartum hemorrhage in an effort to avoid hysterectomy. The use of prophylactic arterial catheterization in the management of cases with expected major postpartum hemorrhage (e.g., placenta increta or percreta) has also been reported. However, the efficacy and safety of this technique requires further study.
  
  
  CONCLUSIONS
  Postpartum hemorrhage is best managed by using a stepwise progressive approach. Manual and pharmacologic interventions are first-line treatments. Second-line treatments are used when bleeding continues; and hysterectomy is reserved for only the most extreme cases. Outcomes may be improved by thorough preparation, anticipating the risk of obstetric hemorrhage, and coordinating consultants for interventional procedures.
authors: aDepartment of Cardiovascular Sciences, KU Leuven and Department of Anesthesiology, UZ Leuven, Leuven, Belgium bDivision of Trauma Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors: Marc
authors: M
authors: Van de Velde
authors: Christian
authors: C
authors: Diez
authors: Albert J
authors: AJ
authors: Varon
mesh_terms: D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006473:Postpartum Hemorrhage / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D011247:Pregnancy
chemical_list: D000933:Antifibrinolytic Agents