Maternal hemorrhage, defined as a cumulative blood loss of greater than or equal to 1,000 mL or blood loss accompanied
by signs or symptoms of hypovolemia within 24 hours after the birth process, remains the leading cause of
maternal mortality worldwide (1). Additional important secondary sequelae from hemorrhage exist and include adult
respiratory distress syndrome, shock, disseminated intravascular coagulation, acute renal failure, loss of fertility, and
pituitary necrosis (Sheehan syndrome).
Hemorrhage that leads to blood transfusion is the leading cause of severe maternal morbidity in the United States
closely followed by disseminated intravascular coagulation (2). In the United States, the rate of postpartum hemorrhage
increased 26% between 1994 and 2006 primarily because of increased rates of atony (3). In contrast, maternal
mortality from postpartum obstetric hemorrhage has decreased since the late 1980s and accounted for slightly more
than 10% of maternal mortalities (approximately 1.7 deaths per 100,000 live births) in 2009 (2, 4). This observed
decrease in mortality is associated with increasing rates of transfusion and peripartum hysterectomy (2–4).
The purpose of this Practice Bulletin is to discuss the risk factors for postpartum hemorrhage as well as its evaluation,
prevention, and management. In addition, this document will encourage obstetrician–gynecologists and other
obstetric care providers to play key roles in implementing standardized bundles of care (eg, policies, guidelines, and
algorithms) for the management of postpartum hemorrhage.
Click here to read the entire bulletin. (ACOG Practice Bulletin No. 183 replaces Practice Bulletin No. 76, October 2006)