Postpartum hemorrhage PPH

• Facts:
  Loss of > 500ml of blood following vaginal delivery
  Loss of >1000ml of blood following Cesarean section
• History / PE:
  Heavy vaginal bleeding postpartum
  Numerous blood clots
  Boggy uterus
• Treatment:
  Bimanual uterine massage
  Fluid resuscitation
  Uterotonic agents (eg. oxytocin, methylergonovine, carboprost)
• Associated With:
  Uterine atony (80%)
• Risk Factors:
  Uterine hyperdistension
  Multiple gestation
  Increased parity
  Prolonged labor