Peripartum Hemorrhage: Recent Updates in Management

Abstract

Peripartum hemorrhage, which can occur during pregnancy, labor, or delivery, is an all-inclusive term for bleeding that can happen from 24+0 weeks of gestation to 12 weeks after birth. It is a serious obstetric emergency that affects the entire world and is linked to both mother and fetal morbidity and mortality. It continues to be difficult to treat and to be a significant financial burden. One to ten percentage of deliveries are being complicated by peripartum hemorrhage, and it is the sixth most common cause of maternal mortality in the UK between 2015 and 2017, accounting for 8% of all maternal deaths. Postpartum hemorrhage can be categorized into primary and secondary categories. The 4Ts (Tone, Trauma, Tissue, and Thrombin) are typically used to describe the etiopathogenesis of primary PPH. Over 70% of primary PPH cases had inadequate uterine contractions or uterine atony as a contributing factor. Clinical detection of bleeding severity necessitates alertness and a high degree of suspicion. It is a preventable cause of maternal death and improvements in pharmacology, anesthesia, blood transfusion/hematological support, and innovative surgical methods have dramatically reduced mortality. Rotational thrombelastometry (ROTEM) testing has recently been proven to be a quicker way to diagnose coagulopathy in those who are bleeding. Early resuscitation to prevent hypovolemic shock, to achieve hemodynamic stability, and other specialized strategies as well as identification and management therapy of the underlying cause(s) of the hemorrhage are crucial in controlling peripartum hemor-rhage. It has been demonstrated that routine delivery room drills, simulations, and quick multidisciplinary team involvement further improve care even when major bleeding happens suddenly. Proper application of all these should make maternal mortality purely due to hemorrhage a rare event.