and Paula Briggs2
(1)
Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
(2)
Sexual and Reproductive Health, Southport and Ormskirk Hospital, Southport, UK
Definition
Bleeding from the genital tract in excess of 500 ml, associated with delivery. Blood loss of over 1000 ml is classified as major, and more than 2,000 ml as severe.
PPH occurs within 3 months of delivery and is considered primary within 24 h and secondary after 24 h.
Incidence
It is estimated globally that about one in ten births are associated with PPH. It is more common in primigravidae, after multiple pregnancy, in association with an APH, a large baby, prolonged or augmented labour, pre-eclampsia, previous APH, and is influenced by how the third stage of labour is managed (use of oxytocics decreases risk).
Aetilogy and Pathogenesis
There are three broad causes of PPH:
1.
Loss of tone of the uterine muscle (atony), with or without retained products of conception
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