Clinical Edge

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Prevention & Management of Postpartum Hemorrhage

Obstet Gynecol; ePub 2017 Oct; ACOG

Obstetricians-gynecologists and other obstetric care providers can play key roles in implementing standardized bundles of care, such as policies, guidelines, and algorithms, for the management of postpartum hemorrhage, according to new clinical management guidelines from the American College of Obstetricians and Gynecologists (ACOG). The new practice bulletin discusses risk factors for postpartum hemorrhage as well as its evaluation, prevention, and management. Among the recommendations and conclusions:

Level A:

  • All obstetric care facilities should have guidelines for the routine administration of uterotonics in the immediate postpartum period.
  • Uterotonic agents should be the first-line treatment for postpartum hemorrhage caused by uterine atony. The specific agent selected, outside of recognized contraindications, is at the health care provider’s discretion because none has been shown to have greater efficacy than others for the treatment of uterine atony.

Level B:

  • When uterotonics fail to adequately control postpartum hemorrhage, prompt escalation to other interventions and escalation of intensity of care and support personnel are indicated.
  • Given the mortality reduction findings, tranexamic acid should be considered in the setting of obstetric hemorrhage when initial medical therapy fails.
  • Obstetrician–gynecologists and other obstetric care providers should work with their institutions to ensure the existence of a designated multidisciplinary response team, a staged postpartum hemorrhage protocol that includes guidelines for escalation of care, and a functioning massive transfusion protocol.


Postpartum hemorrhage. Practice Bulletin No. 183. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2017;130:e168–86.