title: Recent Advances in the Management of Major Postpartum Haemorrhage - A Review.
abstract: Postpartum haemorrhage (PPH) is a leading cause of maternal mortality and morbidity worldwide and 75-90% of these haemorrhage results from uterine atony. Delayed and substandard obstetrics care can kill a woman within hours of Major Obstetric Haemorrhage (MOH). Prenatal identification of at risk women, prompt assessment of blood loss, effective management and involvement of multidisciplinary teams is of utmost importance to save the lives of these women. However, even with the best prenatal care, PPH occurs, it can occur without any risk factors. The first step in management is achieving haemodynamic stability, second being arrest of bleeding, both are done simultaneously. Cases of refractory PPH is managed by postpartum hysterectomy which results in complete inability in hosting a future pregnancy, a psychological impact and risk of intra operative surgical morbidities. This review discusses the current evidence based management of PPH, existing controversies in transfusion of blood and blood products and newer advances in this field. It was conducted by searching the English language medical literature using Medline (1994-2015). The current scenario in developing countries mandates research on newer and practicable strategies to tackle PPH which can be implemented effectively and have an upper edge over the existing practices in the management of PPH.
authors.affiliation: Professor, Department of Obstetrics and Gynaecology, Mahatama Gandhi Medical College and Research , Pillaiyarkuppam, Puducherry, India .
authors.forename: P Reddi
authors.initials: PR
authors.lastname: Rani
authors.affiliation: Associate Professor, Department of Obstetrics and Gynaecology, Mahatama Gandhi Medical College and Research , Pillaiyarkuppam, Puducherry, India .
authors.forename: Jasmina
authors.initials: J
authors.lastname: Begum
keywords: Artery embolisation; Compression sutures; Fibrinogen; Tranexamic acid; Transfusion protocols; Vascular ligation