The majority of the existing research on PPH focuses on
the prevention of PPH, while evidence regarding the
safety and efficacy of treatments for primary PPH is
more varied and controversial.61 The subsequent
discussion of the management of PPH is based primarily
on established protocols that have been developed based
on the experience of clinicians. While in some cases the
clinical benefits of interventions are clearly apparent,
there is room for further research on the efficacy of
various components of the emergency measures
commonly used in response to PPH.
Following careful identification of risk factors, and the
use of active management of the third stage, the third
key aspect in preventing PPH is early recognition of
blood loss. Careful assessment in the immediate
postpartum and prompt intervention when indicated
can help to reduce blood loss. Post delivery, the fundus
should be assessed at regular intervals. Signs and
symptoms that are associated with PPH include visible
bleeding, pallor, rising pulse rate, falling blood pressure,
altered level of consciousness, restlessness, or enlarged
uterus. Table 3 outlines the clinical findings associated
with varying degrees of shock.