Post-partum haemorrhage: definitions, medical and surgical management. A time for change

Any woman who gives birth can have post-partum haemorrhage which may threaten her life. PPH is one of the leading causes of maternal mortality and an important cause for serious morbidity in the developing and developed world. We are at the threshold of major developments in its prevention and treatment due to changing ideas about its definition and medical and surgical management. The implementation of these changes is an essential part of a wider commitment towards saving mothers from complications of childbirth. Introduction, definitions and classification Post-partum haemorrhage (PPH) is a clinical problem of indisputable importance to patients, clinicians and to those interested in achieving equity in reproductive health. As a condition it is almost always associated with meaningful implications to patients. Even the mild self-limiting cases have consequences for the patient's puerperium in the form of fatigue, tiredness, failure to breast-feed and possible need for haematinics or blood transfusion. All are symptoms and consequences of anaemia and acute blood loss. The cascade associated with intractable PPH is an entirely different matter however. It is a spiral of events that challenges the acumen of the attending clinicians and their ability to implement the prepared drills of action to handle such a clinical emergency. PPH can transform a normal woman in labour to a critically ill patient within minutes. The management of such a patient is a real test for the thought processes, resources, organizational effort and the education of a labour ward and its staff. Historically, PPH was one of the leading causes of maternal death in industrialized nations up to the Second World War. It is still a leading cause of maternal death in the rest of the world today. The classification, definition and treatment of PPH have seen almost no change over the