Overview
Definition and Causes
Current definition (WHO/ACOG 2017): Cumulative blood loss ≥1000 mL OR blood loss accompanied by signs/symptoms of hypovolemia within 24 hours of delivery.
Current definition (WHO/ACOG 2017):Cumulative blood loss ≥1000 mL OR blood loss accompanied by signs/symptoms of hypovolemia within 24 hours of delivery. Previous definition: >500 mL after vaginal, >1000 mL after cesarean (still used clinically) Incidence: 1–5% of deliveries; leading cause of maternal mortality worldwide The 4 T's of PPH causes: | T | Cause | Incidence | |---|-------|-----------| | Tone | Uterine atony | 70–80% | | Tissue | Retained placenta/membranes | 10% | | Trauma | Lacerations (cervical, vaginal, perineal, uterine), hematoma, uterine inversion | 10% | | Thrombin | Coagulopathy (DIC, vWD, anticoagulants, HELLP) | Rare | Risk factors (remember ABC): - Atonomy: prolonged labor, multiple gestation, macrosomia, grand multiparity, over-distended uterus - Blood: coagulopathy, anticoagulants, prior hemorrhage - Complications: preeclampsia, abruption, uterine surgery, placenta accreta spectrum