Management of obstetric and gynecologic hemorrhage: a narrative review of current guidelines and evidence.

Obstetric hemorrhage remains one of the leading causes of maternal morbidity and mortality worldwide despite clinical guidelines and effective interventions. Postpartum hemorrhage is the most common and clinically significant form, yet variability persists across guidelines regarding diagnostic criteria, blood-loss assessment, transfusion thresholds, and escalation strategies. In parallel, gynecologic hemorrhage, particularly acute abnormal uterine bleeding, remains an important cause of morbidity and requires a distinct therapeutic approach. This study was conducted as a structured narrative review informed by systematic search principles. A literature search was performed in PubMed, Scopus, and Web of Science for studies published between January 2020 and January 2026, supplemented by targeted searches of guideline repositories and official organizational websites. The review focused on international guidelines and relevant studies on diagnosis, treatment, transfusion practices, and escalation pathways for obstetric and gynecologic hemorrhage. Of 1,248 records identified, 32 studies were included in the final synthesis. Strong convergence was observed regarding early recognition and administration of uterotonics, particularly oxytocin, as first-line therapy, with early use of tranexamic acid as an adjunct within three hours of birth. Increasing evidence supports protocol-driven care over traditional stepwise escalation. Restrictive transfusion strategies are recommended for stable patients, while clinical status remains the primary determinant in patients with active bleeding. Acute abnormal uterine bleeding management relies on antifibrinolytic and hormonal therapy. Contemporary hemorrhage management is increasingly early, physiology-based, multidisciplinary, and protocolized. Optimal outcomes depend on rapid recognition, prompt first-line treatment, and timely escalation. Integrating principles from gynecologic hemorrhage may further strengthen individualized and etiology-driven care.