Overview
Recognise significant postpartum bleeding early, coordinate resuscitation with cause-directed haemostasis, and use uterotonics and blood components safely.
Postpartum haemorrhage is a clinical emergency defined by timing, amount and consequences of bleeding. RCOG traditionally describes primary PPH as at least 500 mL within twenty-four hours, with major PPH exceeding 1,000 mL. WHO's 2025 diagnostic criteria support treatment at measured loss of at least 300 mL with abnormal haemodynamics, or at least 500 mL, whichever occurs first. Operational staging varies between pathways. No volume label should delay intervention in someone with physiological compromise, pre-existing anaemia or limited reserve.
The central task is to stop bleeding while maintaining oxygen delivery and haemostasis. Uterotonics address deficient contraction, but they cannot repair a cervical tear or remove an abnormally adherent placenta safely. Transfusion replaces losses and deficits, but cannot compensate indefinitely for uncontrolled bleeding. Assigning simultaneous resuscitation and obstetric treatment roles prevents one stream from delaying the other.
Key points
- Measure cumulative blood loss and interpret it alongside the woman's physiology.
- Primary PPH occurs within twenty-four hours of birth; later abnormal bleeding follows a secondary-PPH assessment.