open access

Vol 91, No 1 (2020)
REVIEW PAPERS Obstetrics
Published online: 2020-01-31
Get Citation

Epidemiology, prevention and management of early postpartum hemorrhage — a systematic review

Stepan Feduniw, Damian Warzecha, Iwona Szymusik, Miroslaw Wielgos
DOI: 10.5603/GP.2020.0009
·
Pubmed: 32039467
·
Ginekol Pol 2020;91(1):38-44.

open access

Vol 91, No 1 (2020)
REVIEW PAPERS Obstetrics
Published online: 2020-01-31

Abstract

Early Postpartum Hemorrhage (EPH) is one of the leading causes of postpartum mortality. It is defined as blood loss of at
least 500 mL after vaginal or 1000 mL following cesarean delivery within 24 hours postpartum. The following paper includes
literature review aimed to estimate the incidence and predictors of early postpartum hemorrhage (EPH). Available prevention
and treatment methods were also assessed. The inclusion criteria for the study were met by 52 studies.
The exact frequency of EPH in different populations varies from 1.2% to 12.5%. Maternal, pregnancy-associated, laborcorrelated
and sociodemographic risk factors seem to be important predictors of EPH. In these cases appropriate prophylaxis
should be considered. However, EPH may occur without previous risk factors. The main reason for EPH is uterine atony
which contributes to up to 80% of cases of postpartum hemorrhage (PPH). Other common reasons for PPH include genital
tract injuries, placenta accreta or coagulopathies. Interestingly, the majority of uterotonics seem to have a similar effect.
However, carbetocin seems to be the most effective in certain situations.
Appropriate diagnosis of EPH is the most important issue. The treatment should be causative. The first-line treatment should
include uterotonics. Surgical interventions, if required, should be performed without delay, although preoperative uterine
tamponade should be considered due to its high effectiveness.
Medical staff training in medical simulation centers is an important factor that improves the outcomes of EPH treatment.
It provides adaptation to hospital protocols, team work improvement, self-confidence building, more accurate blood loss
evaluation and reduced perception of stress. The implementation of systematic trainings provides better outcomes in the future.

Abstract

Early Postpartum Hemorrhage (EPH) is one of the leading causes of postpartum mortality. It is defined as blood loss of at
least 500 mL after vaginal or 1000 mL following cesarean delivery within 24 hours postpartum. The following paper includes
literature review aimed to estimate the incidence and predictors of early postpartum hemorrhage (EPH). Available prevention
and treatment methods were also assessed. The inclusion criteria for the study were met by 52 studies.
The exact frequency of EPH in different populations varies from 1.2% to 12.5%. Maternal, pregnancy-associated, laborcorrelated
and sociodemographic risk factors seem to be important predictors of EPH. In these cases appropriate prophylaxis
should be considered. However, EPH may occur without previous risk factors. The main reason for EPH is uterine atony
which contributes to up to 80% of cases of postpartum hemorrhage (PPH). Other common reasons for PPH include genital
tract injuries, placenta accreta or coagulopathies. Interestingly, the majority of uterotonics seem to have a similar effect.
However, carbetocin seems to be the most effective in certain situations.
Appropriate diagnosis of EPH is the most important issue. The treatment should be causative. The first-line treatment should
include uterotonics. Surgical interventions, if required, should be performed without delay, although preoperative uterine
tamponade should be considered due to its high effectiveness.
Medical staff training in medical simulation centers is an important factor that improves the outcomes of EPH treatment.
It provides adaptation to hospital protocols, team work improvement, self-confidence building, more accurate blood loss
evaluation and reduced perception of stress. The implementation of systematic trainings provides better outcomes in the future.

Get Citation

Keywords

postpartum hemorrhage; delivery; perinatology; medical simulation

About this article
Title

Epidemiology, prevention and management of early postpartum hemorrhage — a systematic review

Journal

Ginekologia Polska

Issue

Vol 91, No 1 (2020)

Pages

38-44

Published online

2020-01-31

DOI

10.5603/GP.2020.0009

Pubmed

32039467

Bibliographic record

Ginekol Pol 2020;91(1):38-44.

Keywords

postpartum hemorrhage
delivery
perinatology
medical simulation

Authors

Stepan Feduniw
Damian Warzecha
Iwona Szymusik
Miroslaw Wielgos

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