Most cases of postpartum haemorrhage are caused by
uterine atony, maternal soft-tissue
trauma,
retained placenta or its parts, and obstetric coagulopathy. The factors most significantly associated with haemorrhage include advanced maternal age, prolonged labour,
pre-eclampsia,
obesity of mother, multiple pregnancy, a
birth weight of more than 4000g, and previous postpartum haemorrhage. It seems that multiparity itself is only a weakly associated factor. The prophylactic use of
oxytocic drugs (
oxytocin or its combination with
ergometrine at the third stage of labour is always recommended for decreasing the
bleeding.
Prostaglandins should be used as a second line treatment if
uterine atony cannot be abolished by uterine
massage and
oxytocin infusion. In the surgical management, the role of hypogastric artery
ligation is decreasing. The stepwise uterine devascularization may be a reasonable method in the most severe uncontrollable postpartum
bleeding. The uterine tamponade with gauze or specific tubes may also be a useful alternative in some cases. Selective arterial embolization is a promising new method that seems to have success in controlling the heavy postpartum
bleeding unresponsive to more usual measures. However, the value of this method should be evaluated in bigger series.