Nevertheless, use of this definition can be challenging in clinical
practice, and diagnosis is usually made by visual estimation of blood
loss, suggesting that PPH might actually be underdiagnosed [10,11].
This inaccuracy in blood-loss estimation has triggered efforts to deter-
mine the global incidence of PPH [4], and to identify clinical signs that
might objectively relate to blood loss, such as the shock index [12].
Depending on the presence of pre-existing conditions (e.g. anemia), un-
treated PPH can lead to hypovolemic shock, multiorgan dysfunction,
and maternal death [13]. Therefore, timely and accurate identification
of this complication is crucial to ensure that appropriate interventions
are initiated (e.g. drugs, surgery, and referral) and that adverse out-
comes are avoided [14].
For many years, interest in PPH was focused on the evaluation of
risk factors, prevention, and treatment [9]. Other studies have tried to
understand the reasons for substandard care in PPH [8], accurate diag-
nosis [12], and identification of potentially severe cases. To date, few
studies have collected consistent prospective data on severe maternal
Nevertheless, use of this definition can be challenging in clinicalpractice, and diagnosis is usually made by visual estimation of bloodloss, suggesting that PPH might actually be underdiagnosed [10,11].This inaccuracy in blood-loss estimation has triggered efforts to deter-mine the global incidence of PPH [4], and to identify clinical signs thatmight objectively relate to blood loss, such as the shock index [12].Depending on the presence of pre-existing conditions (e.g. anemia), un-treated PPH can lead to hypovolemic shock, multiorgan dysfunction,and maternal death [13]. Therefore, timely and accurate identificationof this complication is crucial to ensure that appropriate interventionsare initiated (e.g. drugs, surgery, and referral) and that adverse out-comes are avoided [14].For many years, interest in PPH was focused on the evaluation ofrisk factors, prevention, and treatment [9]. Other studies have tried tounderstand the reasons for substandard care in PPH [8], accurate diag-nosis [12], and identification of potentially severe cases. To date, fewstudies have collected consistent prospective data on severe maternal
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