Postpartum hemorrhage.

Early PPH remains a significant cause of maternal morbidity and mortality. Many cases occur in women with antecedent risk factors and can thus be anticipated, promptly diagnosed, and promptly treated. Postpartum hemorrhage is most commonly due to uterine atony and often responds to medical treatments such as ecbolic medications, uterine massage or bimanual compression, and blood and fluid replacement. Appropriate laboratory studies should be obtained promptly. Women with significant bleeding should receive blood product transfusions. Patients who do not promptly respond to these conservative measures should be considered and counseled for operative procedures. Surgical intervention, either to repair lacerations, transiently reduce pelvic pulse pressure, or remove the uterus, can be life-saving.