Postpartum hemorrhage

Postpartum hemorrhage is excessive blood loss after childbirth, most commonly caused by uterine atony, in which the uterus does not contract effectively to compress placental blood vessels.

Uterine atony: Failure of the uterus to contract adequately after birth, allowing continued bleeding from placental blood vessels. It is the most common cause of postpartum hemorrhage.
Fourth stage of labor: The period immediately after birth, when the placenta has been delivered and the mother is monitored for complications. Postpartum hemorrhage often begins during this closely observed period.
Quantitative blood loss assessment: Measurement of blood lost during childbirth using collection devices and weighing of blood-soaked materials. Objective measurement can identify dangerous bleeding earlier than visual estimation.
Maternal mortality: The death of a woman during pregnancy or within a defined period after pregnancy ends, from a pregnancy-related cause. Postpartum hemorrhage remains a major preventable cause of maternal death worldwide.
Active management of the third stage of labor: A set of interventions around birth of the placenta intended to reduce postpartum bleeding. Research continues to refine which components best prevent hemorrhage with the least harm.
Four Ts of postpartum hemorrhage: A clinical framework grouping hemorrhage causes as tone, trauma, tissue, and thrombin. It organizes the main causes clinicians assess during bleeding.
Uterine involution: The process by which the uterus returns toward its pre-pregnancy size after childbirth. Effective contraction and involution help close vessels at the placental attachment site.
Obstetric early warning system: A monitoring approach that uses maternal vital signs and clinical changes to flag deterioration. It helps detect shock as hemorrhage progresses.
Hemorrhagic shock: A life-threatening state in which blood loss leaves tissues without adequate oxygenated circulation. Rapid blood loss can progress to shock before visible signs fully reflect its severity.
Carbetocin: A long-acting oxytocin-receptor agonist used to stimulate uterine contraction, including for prevention of postpartum hemorrhage. Its comparative effectiveness, cost, and heat stability matter where refrigeration is limited.

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