Hemorrhage management: be practical, prepared. (Postpartum Blood Loss).

ASHEVILLE, NC. -- The risk of death from postpartum hemorrhage can be minimized by taking a practical approach to management and being prepared for every eventuality, including hysterectomy, Dr. James E. Ferguson II said at the annual Southern Obstetric and Gynecologic Seminar.

"Remember, surgery can be your friend," he said, noting that several steps can be taken first to determine if a non-surgical approach will suffice.

Many of these steps need to be taken simultaneously, said Dr. Ferguson, professor and director of the division of maternal-fetal medicine at the University of Virginia, Charlottesville.

There are numerous causes of postpartum hemorrhage. With uterine bleeding, atony is responsible for at least 70% of cases.

Other risk factors for uterine bleeding include infection, use of uterine relaxing agents, prolonged use of oxytocin, multiparity, and history of prior postpartum hemorrhage.

Uterine rupture, another cause of uterine hemorrhage, is responsible for fewer than 1% of cases. That number is expected to rise due to the increasing number of women with uterine scarring from prior cesarean sections. Rupture is more likely following breech extraction, obstructed labor, abnormal fetal presentation, and midforceps delivery.

Extrauterine causes of bleeding include placental implantation problems, lower genital tract lacerations, and vulvar or vaginal hematomas.