postpartum hemorrhage


Summary: Excess blood loss from uterine bleeding associated with OBSTETRIC LABOR or CHILDBIRTH. It is defined as blood loss greater than 500 ml or of the amount that adversely affects the maternal physiology, such as BLOOD PRESSURE and HEMATOCRIT. Postpartum hemorrhage is divided into two categories, immediate (within first 24 hours after birth) or delayed (after 24 hours postpartum).

Top Publications

  1. Davis D, Baddock S, Pairman S, Hunter M, Benn C, Anderson J, et al. Risk of severe postpartum hemorrhage in low-risk childbearing women in new zealand: exploring the effect of place of birth and comparing third stage management of labor. Birth. 2012;39:98-105 pubmed publisher
    Primary postpartum hemorrhage is a leading cause of maternal mortality and morbidity internationally...
  2. Khireddine I, Le Ray C, Dupont C, Rudigoz R, Bouvier Colle M, Deneux Tharaux C. Induction of labor and risk of postpartum hemorrhage in low risk parturients. PLoS ONE. 2013;8:e54858 pubmed publisher
    ..Our objective was to assess the association between induction of labor and postpartum hemorrhage (PPH) in low-risk parturients, globally and according to its indications and methods...
  3. Gizzo S, Saccardi C, Patrelli T, Di Gangi S, Breda E, Fagherazzi S, et al. Fertility rate and subsequent pregnancy outcomes after conservative surgical techniques in postpartum hemorrhage: 15 years of literature. Fertil Steril. 2013;99:2097-107 pubmed publisher
    ..appropriate surgical technique for optimizing hemostasis and preservation of subsequent fertility after postpartum hemorrhage (PPH). Systematic review of the literature. Not applicable. None...
  4. Bonnet M, Deneux Tharaux C, Dupont C, Rudigoz R, Bouvier Colle M. Transfusion practices in postpartum hemorrhage: a population-based study. Acta Obstet Gynecol Scand. 2013;92:404-13 pubmed publisher
    To describe transfusion practices and anemia in women with postpartum hemorrhage (PPH), according to the clinical context. Population-based cohort study...
  5. Gizzo S, Patrelli T, Gangi S, Carrozzini M, Saccardi C, Zambon A, et al. Which uterotonic is better to prevent the postpartum hemorrhage? Latest news in terms of clinical efficacy, side effects, and contraindications: a systematic review. Reprod Sci. 2013;20:1011-9 pubmed publisher
    b>Postpartum hemorrhage (PPH) is a potentially fatal complication of vaginal and cesarean deliveries...
  6. Lee H, Shin J, Kim J, Yoon H, Ko G, Won H, et al. Primary postpartum hemorrhage: outcome of pelvic arterial embolization in 251 patients at a single institution. Radiology. 2012;264:903-9 pubmed publisher
    To evaluate the safety and efficacy of pelvic arterial embolization (PAE) for the treatment of primary postpartum hemorrhage (PPH) and to determine the factors associated with clinical outcomes...
  7. Oladapo O. Misoprostol for preventing and treating postpartum hemorrhage in the community: a closer look at the evidence. Int J Gynaecol Obstet. 2012;119:105-10 pubmed publisher
    The lack of clear interpretation of clinical and operational evidence on misoprostol use for postpartum hemorrhage (PPH) in the community may jeopardize the realization of its full potential for improving women's survival...
  8. Kramer M, Berg C, Abenhaim H, Dahhou M, Rouleau J, Mehrabadi A, et al. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstet Gynecol. 2013;209:449.e1-7 pubmed publisher
    Because the diagnosis of postpartum hemorrhage (PPH) depends on the accoucheur's subjective estimate of blood loss and varies according to mode of delivery, we examined temporal trends in severe PPH, defined as PPH plus receipt of a ..
  9. Fyfe E, Thompson J, Anderson N, Groom K, McCowan L. Maternal obesity and postpartum haemorrhage after vaginal and caesarean delivery among nulliparous women at term: a retrospective cohort study. BMC Pregnancy Childbirth. 2012;12:112 pubmed publisher
    ..We recommend in addition to standard practice of active management of third stage of labour, there should be increased vigilance and preparation for PPH management in obese women. ..

More Information


  1. Mehrabadi A, Hutcheon J, Lee L, Liston R, Joseph K. Trends in postpartum hemorrhage from 2000 to 2009: a population-based study. BMC Pregnancy Childbirth. 2012;12:108 pubmed publisher
    b>Postpartum hemorrhage, a major cause of maternal death and severe maternal morbidity, increased in frequency in Canada between 1991 and 2004...
  2. Tuncalp O, Hofmeyr G, Gulmezoglu A. Prostaglandins for preventing postpartum haemorrhage. Cochrane Database Syst Rev. 2012;:CD000494 pubmed publisher
  3. Mir A, Wajid A, Gull S. Helping rural women in Pakistan to prevent postpartum hemorrhage: a quasi experimental study. BMC Pregnancy Childbirth. 2012;12:120 pubmed publisher
    ..b>Postpartum hemorrhage is the leading cause of maternal deaths in Pakistan...
  4. Calvert C, Thomas S, Ronsmans C, Wagner K, Adler A, Filippi V. Identifying regional variation in the prevalence of postpartum haemorrhage: a systematic review and meta-analysis. PLoS ONE. 2012;7:e41114 pubmed publisher
    ..However, more reliable estimates will only be obtained with the standardisation of the measurement of PPH so that the data from different regions are comparable. ..
  5. Suzuki S, Hiraizumi Y, Miyake H. Risk factors for postpartum hemorrhage requiring transfusion in cesarean deliveries for Japanese twins: comparison with those for singletons. Arch Gynecol Obstet. 2012;286:1363-7 pubmed publisher
    The aim of this study was to identify the factors associated with the increased risk of postpartum hemorrhage requiring transfusion in Japanese twin pregnancies in comparison with those in Japanese singleton pregnancies...
  6. Chu C, Brhlikova P, Pollock A. Rethinking WHO guidance: review of evidence for misoprostol use in the prevention of postpartum haemorrhage. J R Soc Med. 2012;105:336-47 pubmed publisher
    ..Current evidence does not support misoprostol use in home and community settings in low- and middle-income countries for PPH prevention. WHO should rethink its recent decision to include misoprostol on the Essential Medicines List. ..
  7. Elati A, Weeks A. Risk of fever after misoprostol for the prevention of postpartum hemorrhage: a meta-analysis. Obstet Gynecol. 2012;120:1140-8 pubmed publisher
    To estimate the incidence and risk of misoprostol-induced fever with different doses and routes when used for the prevention of postpartum hemorrhage.
  8. Bryant A, Mhyre J, Leffert L, Hoban R, Yakoob M, Bateman B. The association of maternal race and ethnicity and the risk of postpartum hemorrhage. Anesth Analg. 2012;115:1127-36 pubmed publisher
    ..disparities in obstetric outcomes in the United States, but little is known about disparities in risk of postpartum hemorrhage (PPH)...
  9. Mehrabadi A, Liu S, Bartholomew S, Hutcheon J, Kramer M, Liston R, et al. Temporal trends in postpartum hemorrhage and severe postpartum hemorrhage in Canada from 2003 to 2010. J Obstet Gynaecol Can. 2014;36:21-33 pubmed publisher
    Increases in postpartum hemorrhage have been reported from several countries. We assessed temporal trends in postpartum hemorrhage and severe postpartum hemorrhage in Canada between 2003 and 2010...
  10. Stanton C, Newton S, Mullany L, Cofie P, Agyemang C, Adiibokah E, et al. Impact on postpartum hemorrhage of prophylactic administration of oxytocin 10 IU via Uniject™ by peripheral health care providers at home births: design of a community-based cluster-randomized trial. BMC Pregnancy Childbirth. 2012;12:42 pubmed publisher
    Hemorrhage is the leading direct cause of maternal death globally. While oxytocin is the drug of choice for postpartum hemorrhage prevention, its use has generally been limited to health facilities...
  11. Kausar F, Morris J, Fathalla M, Ojengbede O, Fabamwo A, Mourad Youssif M, et al. Nurses in low resource settings save mothers' lives with non-pneumatic anti-shock garment. MCN Am J Matern Child Nurs. 2012;37:308-16 pubmed
    To discuss the role of nurses and nurse-midwives in preventing and treating postpartum hemorrhage (PPH) from uterine atony in developing countries and examine the role of a new device, the non-pneumatic anti-shock garment (NASG), in ..
  12. Oberg A, Hernandez diaz S, Palmsten K, Almqvist C, Bateman B. Patterns of recurrence of postpartum hemorrhage in a large population-based cohort. Am J Obstet Gynecol. 2014;210:229.e1-8 pubmed publisher
    Although a history of postpartum hemorrhage (PPH) is a recognized risk factor for PPH in subsequent pregnancies, little is known about how the risk accumulates over multiple pregnancies, how recurrence varies by PPH subtype, and whether ..
  13. Stanton C, Newton S, Mullany L, Cofie P, Tawiah Agyemang C, Adiibokah E, et al. Effect on postpartum hemorrhage of prophylactic oxytocin (10 IU) by injection by community health officers in Ghana: a community-based, cluster-randomized trial. PLoS Med. 2013;10:e1001524 pubmed publisher
    Oxytocin (10 IU) is the drug of choice for prevention of postpartum hemorrhage (PPH). Its use has generally been restricted to medically trained staff in health facilities...
  14. Smith J, Gubin R, Holston M, Fullerton J, Prata N. Misoprostol for postpartum hemorrhage prevention at home birth: an integrative review of global implementation experience to date. BMC Pregnancy Childbirth. 2013;13:44 pubmed publisher
    ..The 2012 World Health Organization guidelines for the prevention and management of postpartum hemorrhage (PPH) recommend oral administration of misoprostol by community health workers (CHWs)...
  15. Pirkle C, Dumont A, Traore M, Zunzunegui M. Effect of a facility-based multifaceted intervention on the quality of obstetrical care: a cluster randomized controlled trial in Mali and Senegal. BMC Pregnancy Childbirth. 2013;13:24 pubmed publisher
    ..The association between the intervention and quality of care was the same, irrespective of the level of resources available to a hospital; however, as resources increased, so did quality of care scores in both arms of the trial. ..
  16. Pinto A, Niola R, Brunese L, Pinto F, Losco M, Romano L. Postpartum hemorrhage: what every radiologist needs to know. Curr Probl Diagn Radiol. 2012;41:102-10 pubmed publisher
    b>Postpartum hemorrhage is among the most common causes of maternal morbidity and mortality...
  17. Geller S, Adams M, Miller S. A continuum of care model for postpartum hemorrhage. Int J Fertil Womens Med. 2007;52:97-105 pubmed
    ..Such a multifaceted, systematic, contextualized PPH continuum of care approach may have the greatest impact for saving women's lives. This model should be developed and tested to be region-specific. ..
  18. Hunter L. Exploring the role of uterine artery embolization in the management of postpartum hemorrhage. J Perinat Neonatal Nurs. 2010;24:207-14 pubmed publisher
    b>Postpartum hemorrhage is a potentially life-threatening obstetric emergency that requires prompt nursing and medical interventions...
  19. Porreco R, Stettler R. Surgical remedies for postpartum hemorrhage. Clin Obstet Gynecol. 2010;53:182-95 pubmed publisher
    When medical therapy is unsuccessful, surgical approaches to postpartum hemorrhage are often considered...
  20. Homer C, Kurinczuk J, Spark P, Brocklehurst P, Knight M. A novel use of a classification system to audit severe maternal morbidity. Midwifery. 2010;26:532-6 pubmed publisher
    ..The TGCS may not necessarily be a useful way to monitor other events in childbirth. Further work is needed to develop other classification systems which could be used as a benchmarking tools to monitor patient safety in maternity care. ..
  21. Kolås T, Øian P, Skjeldestad F. Risks for peroperative excessive blood loss in cesarean delivery. Acta Obstet Gynecol Scand. 2010;89:658-63 pubmed publisher
    ..4-7.1) and high BMI (aOR 3.4; 95% CI 1.6-7.2) were risks in emergency operations. The different risk pattern for excessive bleeding in cesarean deliveries should be recognized when planning available obstetric competence for surgery. ..
  22. Bauer S, Bonanno C. Abnormal placentation. Semin Perinatol. 2009;33:88-96 pubmed publisher
    ..As one of the leading causes of postpartum hemorrhage, abnormal placentation involves the attachment of placental villi directly to the myometrium with ..
  23. Fujimoto M, Takeuchi K, Sugimoto M, Maruo T. Prevention of postpartum hemorrhage by uterotonic agents: comparison of oxytocin and methylergometrine in the management of the third stage of labor. Acta Obstet Gynecol Scand. 2006;85:1310-4 pubmed
    ..oxytocin administration compared with intravenous methylergometrine administration for the prevention of postpartum hemorrhage (PPH), and the significance of administration at the end of the second stage of labor compared with that ..
  24. Holm C, Langhoff Roos J, Petersen K, Norgaard A, Diness B. Severe postpartum haemorrhage and mode of delivery: a retrospective cohort study. BJOG. 2012;119:596-604 pubmed publisher
    ..Compared with intended vaginal delivery, planned caesarean delivery was associated with a reduced risk of severe postpartum haemorrhage indicated by use of red blood cell transfusion. ..
  25. Chaudhuri P, Biswas J, Mandal A. Sublingual misoprostol versus intramuscular oxytocin for prevention of postpartum hemorrhage in low-risk women. Int J Gynaecol Obstet. 2012;116:138-42 pubmed publisher
    To compare sublingual misoprostol with intramuscular oxytocin for prevention of postpartum hemorrhage (PPH) in low-risk vaginal birth...
  26. Prata N, Gessessew A, Abraha A, Holston M, Potts M. Prevention of postpartum hemorrhage: options for home births in rural Ethiopia. Afr J Reprod Health. 2009;13:87-95 pubmed
    This paper sought to determine the safety and feasibility of home-based prophylaxis of postpartum hemorrhage (PPH) with misoprostol, including assessment of the need for referrals and additional interventions...
  27. Lee N, Kim S, Lee J, Sol Y, Kim C, Hyun Sung K, et al. Postpartum hemorrhage: Clinical and radiologic aspects. Eur J Radiol. 2010;74:50-9 pubmed publisher
    b>Postpartum hemorrhage (PPH) is a potentially life threatening condition, and it remains the leading cause of maternal morbidity...
  28. Sentilhes L, Ambroselli C, Kayem G, Provansal M, Fernandez H, Perrotin F, et al. Maternal outcome after conservative treatment of placenta accreta. Obstet Gynecol. 2010;115:526-34 pubmed publisher
    ..5 weeks (range 4-60 weeks). Conservative treatment for placenta accreta can help women avoid hysterectomy and involves a low rate of severe maternal morbidity in centers with adequate equipment and resources. ..
  29. Zhang W, Deneux Tharaux C, Brocklehurst P, Juszczak E, Joslin M, Alexander S. Effect of a collector bag for measurement of postpartum blood loss after vaginal delivery: cluster randomised trial in 13 European countries. BMJ. 2010;340:c293 pubmed publisher
    ..69% to 1.02%). Compared with visual estimation of postpartum blood loss the use of a collector bag after vaginal delivery did not reduce the rate of severe postpartum haemorrhage. Current Controlled Trials ISRCTN66197422. ..
  30. Singh G, Radhakrishnan G, Guleria K. Comparison of sublingual misoprostol, intravenous oxytocin, and intravenous methylergometrine in active management of the third stage of labor. Int J Gynaecol Obstet. 2009;107:130-4 pubmed publisher
    ..05). Administration of 600 microg of sublingual misoprostol was more effective than 400 microg of misoprostol, intravenous oxytocin, and intravenous methylergometrine for AMTSL. ..
  31. Sosa C, Althabe F, Belizan J, Buekens P. Risk factors for postpartum hemorrhage in vaginal deliveries in a Latin-American population. Obstet Gynecol. 2009;113:1313-9 pubmed publisher
    To identify risk factors for immediate postpartum hemorrhage after vaginal delivery in a South American population.
  32. Devine P. Obstetric hemorrhage. Semin Perinatol. 2009;33:76-81 pubmed publisher
    ..Depending on the definition that is used, postpartum hemorrhage complicates up to 18% of all deliveries...
  33. Blum J, Alfirevic Z, Walraven G, Weeks A, Winikoff B. Treatment of postpartum hemorrhage with misoprostol. Int J Gynaecol Obstet. 2007;99 Suppl 2:S202-5 pubmed
    A literature review was conducted to determine whether misoprostol is an effective treatment for postpartum hemorrhage (PPH) and in what dose...
  34. Prata N, Ejembi C, Fraser A, Shittu O, Minkler M. Community mobilization to reduce postpartum hemorrhage in home births in northern Nigeria. Soc Sci Med. 2012;74:1288-96 pubmed publisher the uptake of a health intervention, namely, community-based distribution of misoprostol to prevent postpartum hemorrhage. Community mobilization to increase access to misoprostol for postpartum hemorrhage prevention was ..
  35. Oyelese Y, Scorza W, Mastrolia R, Smulian J. Postpartum hemorrhage. Obstet Gynecol Clin North Am. 2007;34:421-41, x pubmed
    b>Postpartum hemorrhage (PPH) is the leading cause of death related to pregnancy worldwide. Most deaths resulting from PPH are preventable...
  36. Oboro V, Adewunmi A, Ande A, Olagbuji B, Ezeanochie M, Oyeniran A. Morbidity associated with failed vaginal birth after cesarean section. Acta Obstet Gynecol Scand. 2010;89:1229-32 pubmed publisher
    ..6%) had failed VBAC. Failed VBAC was associated with higher incidence of chorioamnionitis, postpartum hemorrhage, blood transfusion, uterine rupture, hysterectomy, and composite major neonatal morbidities...
  37. Knight M. Peripartum hysterectomy in the UK: management and outcomes of the associated haemorrhage. BJOG. 2007;114:1380-7 pubmed
    ..The associated haemorrhage is managed in a variety of ways and not universally according to existing guidelines. Further investigation of the outcomes following some of the more innovative therapies for control of haemorrhage is needed. ..
  38. Karoshi M, Keith L. Challenges in managing postpartum hemorrhage in resource-poor countries. Clin Obstet Gynecol. 2009;52:285-98 pubmed publisher
    Managing postpartum hemorrhage depends in part on having a prepared mind, a complement of trained coworkers, and full access to modern therapies...
  39. James A, Paglia M, Gernsheimer T, Grotegut C, Thames B. Blood component therapy in postpartum hemorrhage. Transfusion. 2009;49:2430-3 pubmed publisher
    The purpose of this study was to examine blood component therapy in the treatment of postpartum hemorrhage. Records were reviewed for subjects who delivered during the 5-year period between January 1, 2000, and December 31, 2004, at Duke ..
  40. Elmir R, Schmied V, Jackson D, Wilkes L. Between life and death: women's experiences of coming close to death, and surviving a severe postpartum haemorrhage and emergency hysterectomy. Midwifery. 2012;28:228-35 pubmed publisher
  41. Miller S, Fathalla M, Youssif M, Turan J, Camlin C, Al Hussaini T, et al. A comparative study of the non-pneumatic anti-shock garment for the treatment of obstetric hemorrhage in Egypt. Int J Gynaecol Obstet. 2010;109:20-4 pubmed publisher
    ..38; 95% confidence interval, 0.17-0.85). The NASG, in addition to standardized protocols at tertiary facilities for obstetric hemorrhage and shock, resulted in lower measured blood loss and reduced EAO. ..
  42. Farrar D, Tuffnell D, Airey R, Duley L. Care during the third stage of labour: a postal survey of UK midwives and obstetricians. BMC Pregnancy Childbirth. 2010;10:23 pubmed publisher
    ..Syntometrine(R) is usually used for vaginal births and oxytocin for caesarean births; when this is given and when the cord is clamped varies. ..
  43. Lutomski J, Byrne B, Devane D, Greene R. Increasing trends in atonic postpartum haemorrhage in Ireland: an 11-year population-based cohort study. BJOG. 2012;119:306-14 pubmed publisher
    ..14; 95% CI 11.43-15.11). Increasing rates of atonic PPH highlight the pressing need for research and for clinical audit focusing on aetiological factors, preventative measures and quality of care, to guide current clinical practice. ..
  44. Patted S, Goudar S, Naik V, Bellad M, Edlavitch S, Kodkany B, et al. Side effects of oral misoprostol for the prevention of postpartum hemorrhage: results of a community-based randomised controlled trial in rural India. J Matern Fetal Neonatal Med. 2009;22:24-8 pubmed publisher
    ..the side effects of 600 microg oral misoprostol given for the mother and the newborn to prevent postpartum hemorrhage (PPH)...
  45. Roberts C, Ford J, Algert C, Bell J, Simpson J, Morris J. Trends in adverse maternal outcomes during childbirth: a population-based study of severe maternal morbidity. BMC Pregnancy Childbirth. 2009;9:7 pubmed publisher
    ..Reducing or stabilising PPH rates would halt the increase in adverse maternal outcomes. ..
  46. Fahy K. Third stage of labour care for women at low risk of postpartum haemorrhage. J Midwifery Womens Health. 2009;54:380-386 pubmed publisher
    ..Yet, active management of third stage labor is being imposed on women who have no known risks of postpartum hemorrhage. This article examines the evidence from existing randomised trials comparing active and physiological ..
  47. Knight M, Callaghan W, Berg C, Alexander S, Bouvier Colle M, Ford J, et al. Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy Childbirth. 2009;9:55 pubmed publisher
    b>Postpartum hemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. Several recent publications have noted an increasing trend in incidence over time...
  48. Kramer M, Dahhou M, Vallerand D, Liston R, Joseph K. Risk factors for postpartum hemorrhage: can we explain the recent temporal increase?. J Obstet Gynaecol Can. 2011;33:810-819 pubmed publisher
    To assess risk factors for postpartum hemorrhage (PPH) and the extent to which changes in those risk factors may explain the rising incidence of PPH recently reported from industrialized countries...
  49. King K, Douglas M, Unger W, Wong A, King R. Five unit bolus oxytocin at cesarean delivery in women at risk of atony: a randomized, double-blind, controlled trial. Anesth Analg. 2010;111:1460-6 pubmed publisher
    I.v. bolus oxytocin is used routinely during cesarean delivery to prevent postpartum hemorrhage. Its adverse hemodynamic effects are well known, resulting in a recent change in dose from 10 IU to 5...
  50. Pagel C, Lewycka S, Colbourn T, Mwansambo C, Meguid T, Chiudzu G, et al. Estimation of potential effects of improved community-based drug provision, to augment health-facility strengthening, on maternal mortality due to post-partum haemorrhage and sepsis in sub-Saharan Africa: an equity-effectiveness model. Lancet. 2009;374:1441-8 pubmed publisher
    ..Institute of Child Health and Faculty of Mathematical and Physical Sciences, University College London, and a donation from John and Ann-Margaret Walton. ..
  51. Alfirevic Z, Blum J, Walraven G, Weeks A, Winikoff B. Prevention of postpartum hemorrhage with misoprostol. Int J Gynaecol Obstet. 2007;99 Suppl 2:S198-201 pubmed
    ..a stable, orally active and cheap uterotonic, misoprostol would appear ideally suited to the prevention of postpartum hemorrhage (PPH) in the developing world...
  52. Kavle J, Stoltzfus R, Witter F, Tielsch J, Khalfan S, Caulfield L. Association between anaemia during pregnancy and blood loss at and after delivery among women with vaginal births in Pemba Island, Zanzibar, Tanzania. J Health Popul Nutr. 2008;26:232-40 pubmed
  53. Maslovitz S, Barkai G, Lessing J, Ziv A, Many A. Improved accuracy of postpartum blood loss estimation as assessed by simulation. Acta Obstet Gynecol Scand. 2008;87:929-34 pubmed publisher
    ..We aimed at assessing the accuracy of estimated blood loss by obstetrical teams during a simulated Postpartum hemorrhage (PPH) scenario...
  54. Gayat E, Resche Rigon M, Morel O, Rossignol M, Mantz J, Nicolas Robin A, et al. Predictive factors of advanced interventional procedures in a multicentre severe postpartum haemorrhage study. Intensive Care Med. 2011;37:1816-25 pubmed publisher
    ..Using these predictors in a single score could be a reliable screening tool in patients at risk of persistent genital tract bleeding and needing an AIP. ..
  55. Buckland S, Homer C. Estimating blood loss after birth: using simulated clinical examples. Women Birth. 2007;20:85-8 pubmed
    ..Accurate estimations can ensure that women who experience significant blood loss can receive appropriate care and the published rates of postpartum haemorrhage are correct. ..
  56. Sziller I, Hupuczi P, Papp Z. Hypogastric artery ligation for severe hemorrhage in obstetric patients. J Perinat Med. 2007;35:187-92 pubmed
    ..At present, HAL is one in a spectrum of operative methods to control life-threatening postpartum hemorrhage before hysterectomy...
  57. Zuberi N, Durocher J, Sikander R, Baber N, Blum J, Walraven G. Misoprostol in addition to routine treatment of postpartum hemorrhage: a hospital-based randomized-controlled trial in Karachi, Pakistan. BMC Pregnancy Childbirth. 2008;8:40 pubmed publisher
    b>Postpartum hemorrhage (PPH) remains a major killer of women worldwide. Standard uterotonic treatments used to control postpartum bleeding do not always work and are not always available...
  58. Carroli G, Cuesta C, Abalos E, Gulmezoglu A. Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol. 2008;22:999-1012 pubmed publisher
    ..For a reliable picture of PPH worldwide - its magnitude, distribution and consequences - a global survey tackling this condition is necessary. ..
  59. Prata N, Mbaruku G, Grossman A, Holston M, Hsieh K. Community-based availability of misoprostol: is it safe?. Afr J Reprod Health. 2009;13:117-28 pubmed
    ..evaluates the safety and acceptability of long-term community-based use of misoprostol for management of postpartum hemorrhage (PPH) in home-births, by comparing deliveries with and without misoprostol use in communities of Kigoma, ..
  60. Allen V, Baskett T, O Connell C, McKeen D, Allen A. Maternal and perinatal outcomes with increasing duration of the second stage of labor. Obstet Gynecol. 2009;113:1248-58 pubmed publisher
    ..There was an increase in risk of maternal obstetric trauma, postpartum hemorrhage, puerperal febrile morbidity and composite maternal morbidity, and low 5-minute Apgar score, birth ..
  61. Rueangchainikhom W, Srisuwan S, Prommas S, Sarapak S. Risk factors for primary postpartum hemorrhage in Bhumibol Adulyadej Hospital. J Med Assoc Thai. 2009;92:1586-90 pubmed
    b>Postpartum hemorrhage remains one of the main causes of maternal morbidity and mortality in both developed and developing countries...
  62. Lu M, Muthengi E, Wakeel F, Fridman M, Korst L, Gregory K. Prolonged second stage of labor and postpartum hemorrhage. J Matern Fetal Neonatal Med. 2009;22:227-32 pubmed publisher
    To examine the relationship between prolonged second stage and postpartum hemorrhage (PPH). We conducted a retrospective case-control study of all cases of PPH which occurred at four Southern California hospitals in 2003...
  63. Cristina Rossi A, Mullin P. The etiology of maternal mortality in developed countries: a systematic review of literature. Arch Gynecol Obstet. 2012;285:1499-503 pubmed publisher
    ..90). MD was direct in 6,791 women (MMR: 8.98), being postpartum hemorrhage the leading cause, and indirect in 2,786 women (MMR: 3.68), with cardiovascular disease as the main cause...
  64. Malabarey O, Almog B, Brown R, Abenhaim H, Shrim A. Postpartum hemorrhage in low risk population. J Perinat Med. 2011;39:495-8 pubmed publisher
    To identify risk factors for postpartum hemorrhage (PPH) in low risk patients. All deliveries between 2001 and 2007 were retrieved. Women with well-established preexisting risk factors for PPH were excluded...
  65. Blomberg M. Maternal obesity and risk of postpartum hemorrhage. Obstet Gynecol. 2011;118:561-8 pubmed publisher
    To estimate whether maternal obesity was associated with an increased risk for postpartum hemorrhage more than 1,000 mL and whether there was an association between maternal obesity and causes of postpartum hemorrhage and mode of ..
  66. Prata N, Passano P, Rowen T, Bell S, Walsh J, Potts M. Where there are (few) skilled birth attendants. J Health Popul Nutr. 2011;29:81-91 pubmed
    ..g. misoprostol, family planning, measurement of blood loss, and postpartum care) will increase the chance that women in the lowest economic quintiles will also benefit from global safe motherhood efforts. ..