Management of Massive Obstetric Haemorrhage

Obstetric haemorrhage refers to any bleeding that occurs during pregnancy, delivery or in the postpartum period. It is associated with maternal morbidity and remains the leading cause of direct maternal deaths in developing countries. Antepartum haemorrhage (APH) refers to any genital tract bleeding prior to the delivery of the baby. Identifiable causes of APH include placenta praevia, placental abruption, vasa praevia and local organic pathology such as genital tract tumours. The exact cause of APH remains uncertain in approximately 50% of patients. Postpartum haemorrhage (PPH) refers to excessive bleeding from the genital tract after the delivery of the baby and is termed primary when it occurs within the first 24 hours of birth. Common causes include atonic uterus, genital tract trauma, retained placental tissue and coagulopathy. Secondary PPH occurs after the first 24 hours and is due to retained products of conception and/or infection (endometritis). The management algorithm ‘HAEMOSTASIS’ has been proposed to aid the systematic management of postpartum haemorrhage. A multidisciplinary approach is essential to improve outcomes. Early diagnosis, timely institution of appropriate measures to arrest haemorrhage, replacement of blood volume (intravenous fluids), ensuring oxygen carrying capacity of blood (by blood transfusion) and correction of coagulopathy may help save lives.