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Postpartum haemorrhage: latest developments in prediction, drug treatment and monitoring

02 April 2024
Volume 32 · Issue 4


With increasing global rates of postpartum haemorrhage, recent developments aim to ensure that birthing women are safe. This focused review will discuss developments in prediction of postpartum haemorrhage, blood loss measurement, uterotonic use and the thromboelastogram, aiming to improve prevention and treatment of postpartum haemorrhage. The unpredictable nature of postpartum haemorrhage is a significant hurdle, as all women must be considered at risk, imposing a heavy burden on healthcare services. Evidence-based tools have shown promise in improving prediction and management strategies. However, the lack of consensus and agreement on risk factors presents obstacles to developing accurate models. Ongoing research is exploring the development of an individual postpartum haemorrhage risk index, providing personalised care to pregnant women. Accurate blood loss quantification is essential for prompt postpartum haemorrhage diagnosis and appropriate interventions, but challenging in busy clinical settings. Recent advancements in prophylaxis and treatment using medication (uterotonics and tranexamic acid), as well as in monitoring using thromboelastograms, emphasise the need for effective prediction and management strategies. This critical review underscores the need for further research to enhance prediction tools, refine management protocols and address existing challenges to improve maternal outcomes.

Postpartum haemorrhage continues to be the leading cause of maternal mortality and morbidity in the world (Bienstock et al, 2021). Although death from postpartum haemorrhage is considered a preventable event, postpartum haemorrhage is still responsible for around 8% of maternal deaths in developed countries and 20% in developing countries (Bienstock et al, 2021). A primary postpartum haemorrhage is typically understood as blood loss of ≥500ml within 24 hours of birth (World Health Organization (WHO), 2012). However, the blood loss threshold used by clinicians to trigger interventions may be higher or lower, depending on a woman's situation. Healthy pregnant women can endure greater blood loss, while loss of <500ml may cause severe adverse consequences in women with anaemia or chronic disease (Faysal et al, 2023; Glonnegger et al, 2023). Individualisation of care is therefore important not only to understand a woman's underlying chance of having a postpartum haemorrhage, but also the effect that it might have.

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