Obstetric haemorrhage

Haemorrhage remains a major cause of maternal morbidity and mortality in the developed and developing world. Blood loss of 2500 ml or more is considered to be life-threatening. The most common cause is post-partum haemorrhage, accounting for about half of all cases. Initial management involves patient assessment, estimation of blood loss, obtaining appropriate help, monitoring and resuscitation. Bleeding may be stopped in a number of ways, for example, drugs that promote uterine contraction (uterotonics), external/internal uterine tamponade, arterial ligation and, as a last resort, hysterectomy. Recent advances in the management of haemorrhage include the use of recombinant factor VIIa and interventional radiology, with cell salvage and thromboelastography also emerging as helpful techniques. Early anaesthetic involvement should form part of multidisciplinary management.