title: Postpartum haemorrhage: prevention and treatment.
abstract: Postpartum hemorrhage (PPH) is one of the leading causes of maternal death and severe maternal morbidity worldwide and strategies to prevent and treat PPH vary among international authorities. Areas covered: This review seeks to provide a global overview of PPH (incidence, causes, risk factors), prevention (active management of the third stage of labor and prohemostatic agents), treatment (first, second and third-line measures to control PPH), by also underlining recommendations elaborated by international authorities and using algorithms. Expert commentary: When available, oxytocin is considered the drug of first choice for both prevention and treatment of PPH, while peripartum hysterectomy remains the ultimate life-saving procedure if pharmacological and resuscitation measures fail. Nevertheless, the level of evidence for preventing and treating PPH is globally low. The emergency nature of PPH makes randomized controlled trials (RCT) logistically difficult. Population-based observational studies should be encouraged as they can usefully strengthen the evidence base, particularly for components of PPH treatment that are difficult or impossible to assess through RCT.
authors.affiliation: a Department of Obstetrics and Gynecology , Bordeaux University Hospital, University of Bordeaux , Bordeaux , France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Sentilhes
authors.affiliation: a Department of Obstetrics and Gynecology , Bordeaux University Hospital, University of Bordeaux , Bordeaux , France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Merlot
authors.affiliation: a Department of Obstetrics and Gynecology , Bordeaux University Hospital, University of Bordeaux , Bordeaux , France.
authors.forename: Hugo
authors.initials: H
authors.lastname: Madar
authors.affiliation: b Department of Anesthesiology , Bordeaux University Hospital, University of Bordeaux , Bordeaux , France.
authors.forename: François
authors.initials: F
authors.lastname: Sztark
authors.affiliation: a Department of Obstetrics and Gynecology , Bordeaux University Hospital, University of Bordeaux , Bordeaux , France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Brun
authors.affiliation: c INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité , Paris Descartes University , Paris , France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Deneux-Tharaux
mesh_terms: D000465:Algorithms; D003131:Combined Modality Therapy; D019468:Disease Management; D004876:Ergot Alkaloids / Q000008:administration & dosage; D005260:Female; D006801:Humans; D015994:Incidence; D010121:Oxytocin / Q000008:administration & dosage / Q000627:therapeutic use; D006473:Postpartum Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012307:Risk Factors
chemical_list: D004876:Ergot Alkaloids; D010121:Oxytocin
keywords: Postpartum hemorrhage; active management of third stage of labor; guidelines; hysterectomy; oxytocin; prevention; sulprostone; tranexamic acid; transfusion; treatment