Various Presentations and Management of Women with Primary Postpartum Hemorrhage
DOI:
https://doi.org/10.51985/Keywords:
Postpartum Hemorrhage; Uterine Atony; Retained Placenta; Genital Tract Trauma; Maternal MorbidityAbstract
Objective: To describe the clinical presentations and management modalities among women with primary postpartum hemorrhage (PPH).
Study Design And Setting: Descriptive cross-sectional study conducted in the Department of Obstetrics and Gynecology, Ghulam Muhammad Mahar Medical College/Teaching Hospital, Sukkur.
Methodology: A total of 144 women aged 18–45 years with primary PPH were included. Multiple pregnancy, intrauterine fetal death, chronic medical illness, and known bleeding disorders were excluded. Primary PPH was defined as blood loss >500 mL after vaginal delivery or >1000 mL after cesarean delivery within 24 hours of birth. Clinical presentation, management modality, blood-transfusion requirement, and maternal outcome were recorded and analyzed using SPSS version 25.0.
Results: Uterine atony was the most frequent presentation, occurring in 78/144 women (54.2%), followed by genital-tract trauma in 31 (21.5%), retained placenta in 24 (16.7%), and combined causes in 11 (7.6%). Conservative medical management was sufficient in 67 women (46.5%); 70 (48.6%) required minor surgical management and 7 (4.9%) required major surgical management. Blood transfusion was required in 127 women (88.2%).
Conclusion: Uterine atony was the leading presentation of primary PPH. Most women were managed with medical therapy or minor surgical procedures, while a small proportion required major surgery. Prompt recognition, resuscitation, causedirected treatment, and timely access to blood products and surgical care remain essential
Downloads
References
1. Bienstock JL, Eke AC, Hueppchen NA. Postpartum
hemorrhage. N Engl J Med. 2021;384(17):1635-1645. doi:10.
1056/ NEJMra1513247.
2. Alonso-Burgos A, Díaz-Lorenzo I, Muñoz-Saá L, Gallardo
C, Castellanos T, Cardenas R, et al. Primary and secondary
postpartum haemorrhage: a review for a rationale endovascular
approach. CVIR Endovasc. 2024;7:17. doi:10.1186/s42155-
024-00429-7.
3. Giouleka S, Tsakiridis I, Kalogiannidis I, Mamopoulos A,
Tentas I, Athanasiadis A, et al. Postpartum hemorrhage: a
comprehensive review of guidelines. Obstet Gynecol Surv.
2022;77(11):665-682. doi:10.1097/OGX.0000000000001061.
4. Gallos I, Devall A, Martin J, Middleton L, Beeson L, Galadanci
H, et al. Randomized trial of early detection and treatment of
postpartum hemorrhage. N Engl J Med. 2023;389(1):11-21.
doi:10.1056/NEJMoa2303966.
5. Weeks AD, Akinola OI, Amorim M, Carvalho B, DeneuxTharaux C, Liabsuetrakul T, et al. World Health Organization
recommendation for using uterine balloon tamponade to treat
postpartum hemorrhage. Obstet Gynecol. 2022;139(3):458-
462. doi:10.1097/AOG.0000000000004674.
6. Escobar MF, Nassar AH, Theron G, Barnea ER, Nicholson
W, Ramasauskaite D, et al. FIGO recommendations on the
management of postpartum hemorrhage 2022. Int J Gynaecol
Obstet. 2022;157 Suppl 1:3-50. doi:10.1002/ijgo.14116.
7. Günaydýn B. Management of postpartum haemorrhage. Turk
J Anaesthesiol Reanim. 2022;50(6):396-402. doi:10.5152
/TJAR.2022.21438.
8. Aimagambetova G, Zhumanova Z, Issanov A, Terzic S, Terzic
M. Management of postpartum hemorrhage in low-resource
settings. J Clin Med. 2024;13(23):7387. doi:10.3390/
jcm13237387.
9. Corbetta-Rastelli CM, Friedman AM, Sobhani NC, Arditi B,
Goffman D, Wen T. Postpartum hemorrhage trends and
outcomes in the United States, 2000-2019. Obstet Gynecol.
2023;141(1):152-161. doi:10.1097/AOG.0000000000004972.
10. Wang MJ, Schapero M, Iverson R, Yarrington CD. Postpartum
hemorrhage. Obstet Gynecol Clin North Am. 2024;51(1):1-
15. doi:10.1016/j.ogc.2023.10.001.
11. Sörsjö Stevenazzi A, Pihl S, Blomberg M, Axelsson D. The
association between maternal vitamin D deficiency and
postpartum hemorrhage and uterine atony. Acta Obstet Gynecol
Scand. 2024;103(2):286-293. doi:10.1111/aogs.14719.
12. Pettersen S, Falk RS, Vangen S, Nyfløt LT. Tone or tissue?
A comparison of trends and risk factors of severe postpartum
hemorrhage according to uterine atony or retained tissue in
a hospital setting. PLoS One. 2025;20(2):e0318770. doi:10.
1371/journal.pone.0318770.
13. Hamdan M, Rahman RA, Tan LK, Omar SZ, Zainuddin AA,
Othman NH, et al. Postpartum haemorrhage burden,
management and challenges in Malaysia: a scoping review
and expert recommendations for effective management.
Cureus. 2025;17(8):e89915. doi:10.7759/cureus.89915.
14. Schulte RL, Fox R, Anderson J, Young N, Davis L, Saxton
V, et al. Medical management of retained products of
conception: a prospective observational study. Eur J Obstet
Gynecol Reprod Biol. 2023;285:153-158. doi:10.1016/j.ejogrb.
2023.04.012.
5. Overton E, D’Alton M, Goffman D. Intrauterine devices in
the management of postpartum hemorrhage. Am J Obstet
Gynecol. 2024;230(3S):S1076-S1088. doi:10.1016/j. ajog.
2023.08.015.
16. Jung YW, Kim J, Shin WK, Song SY, Choi JS, Hyun SH, et
al. Outcomes and prognosis of postpartum hemorrhage
according to management protocol: an 11-year retrospective
study from two referral centers. World J Emerg Surg.
2024;19:27. doi:10.1186/s13017-024-00556-5.
17. Hofer S, Blaha J, Collins PW, Ducloy-Bouthors AS, Guasch
E, Labate F, et al. Haemostatic support in postpartum
haemorrhage: a review of the literature and expert opinion.
Eur J Anaesthesiol. 2023;40(1):29-38. doi:10.1097/EJA.
0000000000001744.
18. Li J, Wang Y, Zhang H, Chen L, Liu X, Huang Y, et al.
Postpartum haemorrhage following vaginal delivery: a
comprehensive analysis and development of predictive models
for aetiological subgroups in Chinese women. BMJ Open.
2025;15:e089734. doi:10.1136/bmjopen-2024-089734.
19. Overton E, D’Alton M, Goffman D. Use of nonsurgical
hemorrhage-control devices for postpartum hemorrhage. Am
J Obstet Gynecol. 2024;230(3S):S1076-S1088. doi:10.1016
/j.ajog.2023.08.015.
20. Ende HB, Lozada MJ, Chestnut DH, Osmundson SS, Walden
RL, Shotwell MS, et al. Risk factors for atonic postpartum
hemorrhage: a systematic review and meta-analysis. Obstet
Gynecol. 2021;137(2):305-323. doi:10.1097/AOG.
0000000000004228.
21. Cole NM, Friedman AM, D’Alton ME, Goffman D. Secondline uterotonics for uterine atony: a randomized clinical trial.
Obstet Gynecol. 2024;144(5):689-697. doi:10.1097/AOG.
0000000000005712.
22. Mitta K, Tsakiridis I, Dagklis T, Mamopoulos A, Kalogiannidis
I, Athanasiadis A. Incidence and risk factors for postpartum
hemorrhage. Medicina (Kaunas). 2023;59(6):1151. doi:10.
3390/medicina59061151.
23. Begum F, Escobar MF, Nassar AH, Theron G, Nicholson W,
Ramasauskaite D, et al. FIGO recommendations on objective
measurement of blood loss after birth. Int J Gynaecol Obstet.
2025;169(1):12-22. doi:10.1002/ijgo.70523.
24. Sadiku OD, Aina SA, Odoemene CC, Ogunmoyin TE, Adedara
VO, Olasimbo O, et al. Approaches to the prevention and
treatment of postpartum hemorrhage: a systematic review of
past advances, recent developments, and best practices. Cureus.
2024;16(8):e65096. doi:10.7759/cureus.65096.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Journal of Bahria University Medical & Dental College is an open access journal and is licensed under CC BY-NC 4.0. which permits unrestricted non commercial use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0
