4. Guideline
4.1 Principles of care
PPH is recognised early and prompt treatment initiated in order to reduce the associated morbidities and
mortality. Effective teamwork and communication is essential with resuscitation, monitoring, investigation and
directed treatment conducted simultaneously 6
. Management includes addressing the 4 causes of PPH; uterine
atony, retained tissue, genital tract trauma and clotting disorders. These are commonly known as the ‘4 T’s’;
tone, tissue, trauma and thrombin.
Active management of third stage is recommended to all women as this reduces the risk of PPH and the need
for blood transfusion
.
4.2 Incidence
The incidence of PPH within Australia and New Zealand is between 5-15%
.
4.3 Risks
The table below outlines some common risk factors for PPH. These risks should be identified both antenatally
and during labour. Other risk factors to consider are a previous history of PPH and any previous uterine surgery,
including but not limited to caesarean birth, myomectomy, STOP, dilatation and curettage (D and C). However
two thirds of women who have a PPH have no known risk factors