Postpartum hemorrhage, the loss of more than 500 mL of blood after delivery, occurs in up
to 18 percent of births and is the most common maternal morbidity in developed countries.
Although risk factors and preventive strategies are clearly documented, not all cases are expected
or avoidable. Uterine atony is responsible for most cases and can be managed with uterine massage in conjunction with oxytocin, prostaglandins, and ergot alkaloids. Retained placenta is a less
common cause and requires examination of the placenta, exploration of the uterine cavity, and
manual removal of retained tissue. Rarely, an invasive placenta causes postpartum hemorrhage
and may require surgical management. Traumatic causes include lacerations, uterine rupture,
and uterine inversion. Coagulopathies require clotting factor replacement for the identified deficiency. Early recognition, systematic evaluation and treatment, and prompt fluid resuscitation
minimize the potentially serious outcomes associated with postpartum hemorrhage.