Primary Postpartum Hemorrhage

Postpartum hemorrhage (PPH) is defined as blood loss exceeding 500 ml following vaginal birth and severe PPH is characterized as a loss of more than 1000 ml, while in cases of caesarean birth PPH is defined as blood loss exceeding 1000 ml.¹  The incidence of PPH differs widely according to the definition and criteria used, methods of measuring postpartum blood loss, and the population being studied, with the highest incidence reported in low- and lower-middle-income countries.²

Each  year, worldwide, about  14  million  people of women have postpartum hemorrhage, with about 70 000 of them ending in death.¹ In the immediate postpartum  period, complications of postpartum  hemorrhage  include hypovolemic shock from massive blood loss, disseminated intravascular coagulopathy, acute renal failure, hepatic failure, and complications of blood transfusion,  including transfusion-related acute lung injury, acute respiratory distress syndrome,  transfusion-associated  circulatory over- load, and death. Late complications e.g. pituitary necrosis and pan- hypopituitarism as well as infertility may also occur.³

In Egypt, according to the last demographic and health survey, postpartum hemorrhage contributed to 19% of causes of maternal mortality.⁴

Late recognition and inadequate response are major contributors to the morbidity and mortality in PPH. This is why guidelines for management of postpartum hemorrhage emphasize early recognition and prompt response.