1. Purpose and scope
Primary postpartum haemorrhage (PPH) is the most common form of major obstetric haemorrhage. The
traditional definition of primary PPH is the loss of 500 ml or more of blood from the genital tract within 24
hours of the birth of a baby.
1 PPH can be minor (500–1000 ml) or major (more than 1000 ml). Major could
be divided to moderate (1000–2000 ml) or severe (more than 2000 ml). The recommendations in this
guideline apply to women experiencing primary PPH of 500 ml or more. Secondary PPH is defined as
abnormal or excessive bleeding from the birth canal between 24 hours and 12 weeks postnatally.
2 This
guideline also includes recommendations specific to the management of major secondary PPH.Women with
pre-existing bleeding disorders such as haemophilia and women taking therapeutic anticoagulants are at
increased risk of PPH;this guideline does not include specific recommendations for the management of such
situations,nor for managing haemorrhage in women who refuse blood transfusion.Guidance on these topics
is available from other sources.
3–6 The guideline has been developed primarily for clinicians working in
consultant-led obstetric units in the UK;recommendations may be less appropriate for other settings where
facilities,resources and routine practice differ.