Snapshot A 17 year-old G1P1 woman undergoes a spontaneous delivery of a 4200 g (9 lb 4 oz) newborn boy with Apgar scores of 8 and 9 at 1 and 5 minutes. She began experiencing the onset of regular contractions 8 hours before delivery. She was administered IV oxytocin for the last 5 hours of labor. After the placenta was delivered, she experienced postpartum hemorrhage with an estimated blood loss of 1200 mL. Introduction Overview postpartum hemorrhage is defined as blood loss of ≥ 500 mL after vaginal delivery or > 1000mL of blood after cesarean delivery leading cause of maternal mortality Epidemiology Incidence occurs in approximately 5-13% of pregnancies in the US and industrialized countries ETIOLOGY Pathophysiology usually occurs immediately after the delivery of the placenta potential etiologies uterine atony login to view 4 more bullets retained placental tissue login to view 3 more bullets trauma (i.e., lacerations) login to view 5 more bullets coagulation disorder login to view 7 more bullets uterine inversion login to view 1 more bullet Presentation Symptoms heavy vaginal bleeding signs and symptoms of hypovolemic shock tachycardia quick, shallow breathing weakness and fatigue confusion cool and clammy skin Treatment Medical fluid resuscitation blood transfusion fresh frozen plasma and cryoprecipitate infusions if abnormal coagulation test findings manage underlying causes uterine atony login to view 2 more bullets Surgical suturing of lacerations uterine artery ligation uterine arteries provide 90% of uterine blood flow hysterectomy curative for bleeding arising from the uterus, cervix, and vagina Complications Hemodynamic instability and organ failure incidence up to 60% of women wiht postpartum hemorrhage treatment fluids and blood transfusion Sheehan syndrome (i.e., postpartum hypopituitarism) pituitary gland is prone to infarction from hypovolemic shock due to severe postpartum hemorrhage incidence rare treatment supplementation of pituitary hormones