Continuing Medical Education

Alerts for managing postpartum haemorrhage

S Fawcus


A review of maternal deaths from postpartum haemorrhage (PPH) in 2014 - 2016 raises concern at the slow rate of reduction of mortality. Folder review showed that 87.8% of deaths were avoidable and identified ‘red flags’: common omissions (poor problem recognition), commissions (incorrect treatment) and areas of substandard care (inadequate monitoring and/or management). The lessons learnt have led to key practice points for managing PPH, which are presented in this article. These include: referral to an appropriate level of care for delivery, medications for prevention of PPH, and how facilities can be prepared for PPH to detect it timeously – before the onset of coagulopathy. Emergency management of severe obstetric haemorrhage includes resuscitation, identifying the cause/s of the bleeding, medical treatment of PPH, non-medical interventions for PPH in the labour ward, early recourse to theatre with ongoing bleeding and a description of effective surgical interventions. The problems associated with referral of patients with PPH are discussed. Updated management algorithms for PPH in South Africa are presented.

Author's affiliations

S Fawcus, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, South Africa

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Maternal mortality; Postpartum haemorrhage; Prevention and emergency management

Cite this article

South African Medical Journal 2018;108(12):1013-1017. DOI:10.7196/SAMJ.2018.v108i12.13420

Article History

Date submitted: 2018-11-26
Date published: 2018-11-26

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