Review: Prevention of postpartum haemorrhage (PPH) and deaths from PPH

The occurrence of PPH can be minimised by addressing preventable factors that lead to haemorrhage and the appropriate management of the third stage of labour. The antenatal detection and treatment of anaemia plays a critical role in decreasing morbidity and mortality from PPH. Other factors placing women at risk of PPH include increased parity, increased maternal age, obesity, polyhydramnios, multiple pregnancy, known placenta praevia and abruptio placenta. Women identified with such factors should be delivered in hospitals with 24 hour caesarean section services. Their labours should have a skilled attendant, active management of the third stage and close observation in the first 4 hours after birth. All attempts must be made to prevent haemorrhage, detect it early and prevent it from becoming massive by aggressive use of uterotonic agents and early recourse to surgical measures to arrest haemorrhage.