Baldwin HJ, Patterson JA, Nippita TA Maternal and neonatal outcomes following abnormally invasive placenta: a population-based record linkage study. Acta Obstet Gynecol Scand. 2017; 96:(11)1373-81

Balki M, Erik-Soussi M, Kingdom J, Carvalho JC. Oxytocin pretreatment attenuates oxytocin-induced contractions in human myometrium in vitro. Anesthesiology. 2013; 119:(3)552-61

Balki M, Ramachandran N, Lee S, Talati C. The recovery time of myometrial responsiveness after oxytocin-induced desensitization in human myometrium in vitro. Anesth Analg. 2016; 122:(5)1508-15

Begley CM, Gyte GM, Devane D, McGuire W, Weeks A. Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev. 2015; (3)

Belfort MA, Shamshirsaz AA, Fox KA. The diagnosis and management of morbidly adherent placenta. Semin Perinatol. 2017; 42:(1)49-58

Bell AF, Erickson EN, Carter CS. Beyond labor: the role of natural and synthetic oxytocin in the transition to motherhood. J Midwifery Womens Health. 2014; 59:(1)35-42

Burguet A, Rousseau A. Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 6: Fetal, neonatal and pediatric risks and adverse effects of using oxytocin augmentation during spontaneous labor. J Gynecol Obstet Hum Reprod. 2017; 46:(6)523-30

Ceriana Cernadas JM. Timing of umbilical cord clamping of term infants. Arch Argent Pediatr. 2017; 115:(2)188-94

Dahlke JD, Mendez-Figueroa H, Maggio L Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines. Am J Obstet Gynecol. 2015; 213:(1)76.e1-76.e10

Dahlke JD, Bhalwal A, Chauhan SP. Obstetric emergencies: shoulder dystocia and postpartum hemorrhage. Obstet Gynecol Clin North Am. 2017; 44:(2)231-43

Deneux-Tharaux C, Sentilhes L, Maillard F Effect of routine controlled cord traction as part of the active management of the third stage of labour on postpartum haemorrhage: multicentre randomised controlled trial (TRACOR). BMJ. 2013; 346

Erickson EN, Lee CS, Emeis CL. Role of prophylactic oxytocin in the third stage of labor: physiologic versus pharmacologically influenced labor and birth. J Midwifery Womens Health. 2017; 62:(4)418-24

Farquhar CM, Li Z, Lensen S Incidence, risk factors and perinatal outcomes for placenta accreta in Australia and New Zealand: a case–control study. BMJ Open. 2017; 7:(10)

Fitzpatrick K, Sellers S, Spark P, Kurinczuk J, Brocklehurst P, Knight M. The management and outcomes of placenta accreta, increta, and percreta in the UK: a population-based descriptive study. BJOG. 2014; 121:(1)62-71

Frass KA. Postpartum hemorrhage is related to the hemoglobin levels at labor: Observational study. Alexandria J Med. 2015; 51:(4)333-7

Freedman D, Brown AS, Shen L, Schaefer CA. Perinatal oxytocin increases the risk of offspring bipolar disorder and childhood cognitive impairment. J Affect Disord. 2015; 173:65-72

Goh WA, Zalud I. Placenta accreta: diagnosis, management and the molecular biology of the morbidly adherent placenta. J Matern Fetal Neonatal Med. 2016; 29:(11)1795-800

Gu V, Feeley N, Gold I Intrapartum synthetic oxytocin and its effects on maternal well-being at 2 months postpartum. Birth. 2016; 43:(1)28-35

Hofmeyr GJ, Abdel-Aleem H, Abdel-Aleem MA. Uterine massage for preventing postpartum haemorrhage. Cochrane Database Syst Rev. 2013;

Hofmeyr GJ, Mshweshwe NT, Gülmezoglu AM. Controlled cord traction for the third stage of labour. Cochrane Database Syst Rev. 2015;

Hofmeyr GJ, Qureshi Z. Preventing deaths due to haemorrhage. Best Pract Res Clin Obstet Gynaecol. 2016; 36:68-82

Ker K, Shakur H, Roberts I. Does tranexamic acid prevent postpartum haemorrhage? A systematic review of randomised controlled trials. BJOG. 2016; 123:(11)1745-52

Khajehei M. Labour and beyond: The roles of synthetic and endogenous oxytocin in transition to motherhood. British Journal of Midwifery. 2017; 25:(4)230-8

Knight M, Paterson-Brown S Messages for care of women with haemorrhage or amniotic fluid embolism. In: Knight M, Nair M, Tuffnell D (eds). Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2017

McCormack PL. Tranexamic acid. Drugs. 2012; 72:(5)585-617

Mpemba F, Kampo S, Zhang X. Towards 2015: post-partum haemorrhage in sub-Saharan Africa still on the rise. Journal of Clinical Nursing. 2014; 23:(5-6)774-83

Nair M, Choudhury MK, Choudhury SS Association between maternal anaemia and pregnancy outcomes: a cohort study in Assam, India. BMJ Glob Health. 2016; 1:(1)

Novikova N, Hofmeyr GJ, Cluver C. Tranexamic acid for preventing postpartum haemorrhage. Cochrane Database Syst Rev. 2015;

Nyfløt LT, Sandven I, Stray-Pedersen B Risk factors for severe postpartum hemorrhage: a case-control study. BMC Pregnancy Childbirth. 2017; 17:(1)

Oberg AS, Hernandez-Diaz S, Palmsten K, Almqvis C, Bateman BT. Patterns of recurrence of postpartum hemorrhage in a large population-based cohort. Am J Obst Gynecol. 2014; 210:(3)229.e1-8

Page K, McCool WF, Guidera M. Examination of the pharmacology of oxytocin and clinical guidelines for use in labor. J Midwifery Womens Health. 2017; 62:(4)425-33

Rousseau A, Burguet A. Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 5: Maternal risk and adverse effects of using oxytocin augmentation during spontaneous labor. J Gynecol Obstet Hum Reprod. 2017; 46:(6)509-21

Green top guideline no. 52: Prevention and management of postpartum haemorrhage.London: RCOG; 2016

Sadek S, Kayaalp E, Movva V, Dad N. 398: Prophylactic tranexamic acid usage in prevention of postpartum hemorrhage a pilot study. Am J Obstet Gynecol. 2018; 218:(1)

Say L, Chou D, Gemmill A Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014; 2:(6)e323-3

Sebghati M, Chandraharan E. An update on the risk factors for and management of obstetric haemorrhage. Womens Health. 2017; 13:(2)34-40

Sentilhes L, Daniel V, Darsonval A Study protocol. TRAAP - TRAnexamic Acid for Preventing postpartum hemorrhage after vaginal delivery: a multicenter randomized, double-blind, placebo-controlled trial. BMC Pregnancy Childbirth. 2015a; 15:(1)

Sentilhes L, Lasocki S, Ducloy-Bouthors A Tranexamic acid for the prevention and treatment of postpartum haemorrhage. Br J Anaes. 2015b; 114:(4)576-87

Sentilhes L, Winer N, Azria E 1: Tranexamic acid for the prevention of postpartum hemorrhage after vaginal delivery: the TRAAP trial. Am J Obstet Gynecol. 2018; 218:(1)S2-3

Shakur H, Roberts I, Fawole B. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017; 389:(10084)2105-16

Sheldon W, Blum J, Vogel J, Souza J, Gülmezoglu A, Winikoff B. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG. 2014; 121:5-13

Tort J, Rozenberg P, Traoré M, Fournier P, Dumont A. Factors associated with postpartum hemorrhage maternal death in referral hospitals in Senegal and Mali: a cross-sectional epidemiological survey. BMC Pregnancy Childbirth. 2015; 15:(1)

Vogel JP, Oladapo OT, Dowswell T, Gülmezoglu AM. Updated WHO recommendation on intravenous tranexamic acid for the treatment of post-partum haemorrhage. Lancet Glob Health. 2018; 6:(1)e18-19

Weeks A. The prevention and treatment of postpartum haemorrhage: what do we know, and where do we go to next?. BJOG. 2014; 122:(2)202-10

Weeks AD. Tranexamic acid for postpartum haemorrhage: a major advance. Lancet Glob Health. 2018; 6:(2)e132-3

Westhoff G, Cotter AM, Tolosa JE. Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage. Cochrane Database Syst Rev. 2013; 10

WHO recommendations for the prevention and treatment of postpartum haemorrhage.Geneva: WHO; 2012

Postpartum haemorrhage: Aetiology and intervention

02 April 2018
Volume 26 · Issue 4


Postpartum haemorrhage is a leading cause of maternal morbidity and mortality worldwide. A common aetiology is uterine atony, which can often be related to the intrapartum management of labour; but an increasingly common cause is abnormally adherent placentation, which is occurring more often due to rising caesarean rates. While intervention can increase the risk of postpartum haemorrhage, it also has its place in its prevention. Hopefully, a balance can be found to improve outcomes both in the short- and long-term.

Postpartum haemorrhage is a major cause of maternal morbidity and mortality worldwide (Knight and Paterson-Brown, 2017). It accounts for one-quarter of all maternal deaths and 100 000 deaths every year, with one woman dying every 4 minutes as a result of postpartum haemorrhage alone (Sentilhes et al, 2015a; Sebghati and Chandraharan, 2017; Shakur et al, 2017). The picture is particularly bleak in low-resource regions such as sub-Saharan Africa, where the absence of skilled birth attendants at births, under-use or lack of uterotonics, and delayed access to emergency obstetric provision makes postpartum haemorrhage a major problem (Mpemba et al, 2014; Sheldon et al, 2014). The mortality rate due to postpartum haemorrhage has dramatically fallen in the UK, such that it is now relatively rare, with a mortality rate of 0.4 per 100 000 maternities, but in sub-Saharan Africa the rate is closer to 150 per 100 000 maternities (Weeks, 2014). As well as the extremely worrying maternal death rate, postpartum haemorrhage can result in severe maternal morbidity, including anaemia, the need for multiple blood transfusions, organ failure, and hysterectomy (Sheldon et al, 2014; Sebghati and Chandraharan, 2017); and the incidence of postpartum haemorrhage is increasing worldwide (Weeks, 2014; Nyfløt et al, 2017), despite the established use of preventative interventions such as active management of the third stage of labour (Say et al, 2014). In fact, this increase may be due, in part at least, to the increasing use of intervention during labour and birth (Weeks, 2014).

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month