531:) Stimulation of oxytocin receptors in the uterine muscle leads to contractions. The number of these receptors increases during pregnancy and with labor. There are also more in the fundus than in the lower uterine segment. Oxytocin has a quick onset of action, within a few minutes, but also loses effectiveness quickly because of a short half-life. The medicine is given in a rapid infusion and may cause hypotension. Oxytocin alone is the usually treatment of atony in the US. However, if bleeding is uncontrolled after administration of oxytocin, then a second uterotonic is given.
3193:
32:
663:
women with a hemoglobin value less than 7 g/dL. In most cases of uterine atony-related postpartum hemorrhage, the amount of iron lost is not fully replaced by the transfused blood. Oral iron should thus be also considered. Parenteral iron therapy is an option as it accelerated recovery. Most women with mild to moderate anemia, however, resolve the anemia sufficiently rapidly with oral iron alone and do not need parenteral iron.
757:
537:: A synthetic analog of oxytocin, works similarly to oxytocin but the half-life is much longer. It binds to smooth muscle receptors of the uterus, like oxytocin and has been reported to produce a stable uterine contraction, followed by rhythmic contractions. It is not available in the US but is available in many countries for the prevention of uterine atony and hemorrhage.
217:, which is an emergency and potential cause of fatality. Across the globe, postpartum hemorrhage is among the top five causes of maternal death. Recognition of the warning signs of uterine atony in the setting of extensive postpartum bleeding should initiate interventions aimed at regaining stable uterine contraction.
311:
is released continuously during labor to stimulate uterine muscle contraction so that the fetus can be delivered and it is continued to be released after delivery to stop blood flow. If the oxytocin receptors become desensitized and no longer respond to the hormone then the uterus does not contract.
662:
Postpartum anemia is common after an episode of uterine atony and postpartum hemorrhage. Severe anemia due to PPH may require red cell transfusions, depending on the severity of anemia and the degree of symptomatology attributable to anemia. A common practice is to offer a transfusion to symptomatic
607:
Uterine artery ligation, with or without ligation of the tubo-ovarian vessels. Ligation of the uterine and utero-ovarian arteries can decrease uterine bleeding by reducing the pressure of arterial blood flow in the uterus. It will not completely control the bleeding but may decrease blood loss while
319:
Blood loss is an expected part of labor and less than 500 mL is considered normal. Generally, primary PPH is classified as being more than 500 mL of blood lost in the first 24 hours following delivery. Those who have a caesarean section typically have more blood loss than a vaginal birth; so 1000 mL
225:
There are many risk factors for uterine atony and several are due to the type of labor a mother experiences such as prolonged labor, labor lasting less than 3 hours, uterine inversion, the use of magnesium sulfate infusions, and extended use of oxytocin. Uterine distention caused by things like more
575:
After the medication is administered, the mother should be closely observed for to confirm the bleeding has stopped. If the bleeding has not stopped or physical exam does not show signs of restored uterine function within 30 minutes of medication administration, immediate invasive interventions are
564:
oral medication that can stimulate uterine contractions. Misoprostol does not need to be refrigerated because it is heat stable. It is easy to administer compared with oxytocin and ergot alkaloids in low-resource areas where refrigeration and sterile needles are not available. May cause a low-grade
328:
Identifying risk factors early in the pregnancy is essential in managing uterine atony and PPH. This allows for planning and organizing the necessary resources including staff, medicines, assistive devices, and the proper blood products. The delivery plan should also be cognizant of the ability of
345:
region may still be squeezing while the lower uterine segment is non-functional. This can be difficult to see with a cursory abdominal examination and easily overlooked. Therefore, a comprehensive vaginal, abdominal, and rectal examination should be performed. The physical examination may include
519:
There are several different types of uterotonic drugs that may be given, and the each has its own advantages and disadvantages. Moreover, the use of combination uterotonic therapy is a common practice and might be more effective at controlling bleeding than monotherapy. Some combinations might
491:
is routinely implemented and is considered the standard for patient care. It can be utilized to reduce the risk of PPH. Active management of the third stage includes uterine massage and a IV low dose oxytocin. Whether it is given just before or after the delivery of the placenta is subject to
543:: This is an ergot alkaloid and has multiple mechanisms of action to induce fast, regular uterine contractions which leads to sustained uterine contraction. It can cause peripheral vasoconstriction and is contraindicated in patients with hypertension or pregnancy related hypertension.
582:
techniques include uterine packing (extending into the vagina) with gauze that also has a Foley catheter in place to allow for bladder drainage. It is inexpensive and readily available. Balloon tamponade is the suggested method of tamponade in guidelines for management of PPH. A
1503:
587:
to tamponade (also with vaginal packing) can be used with Foley catheter insertion to facilitate bladder drainage. Vacuum-induced uterine tamponade is newer technique that uses low-level vacuum to evacuate blood from the uterine cavity and facilitate uterine contraction
499:
A uterine massage is performed by placing a hand on the lower abdomen and using repetitive massaging or squeezing movements in attempt to stimulate the uterus. It is theorized, the massaging motion stimulates uterine contraction and may also trigger the release of local
332:
Most diagnoses of uterine atony are made during the physical exam directly upon completion of the delivery. Diffuse uterine atony is typically diagnosed by patient observation rather than blood loss. The uterus can be directly palpated or observed indirectly using a
204:
is the failure of the uterus to contract adequately following delivery. Contraction of the uterine muscles during labor compresses the blood vessels and slows flow, which helps prevent hemorrhage and facilitates coagulation. Therefore, a lack of uterine
1511:
658:
In low‐income countries there are several other factors that play a role in PPH risk. Poor nutritional status, lack of healthcare access, and limited blood product supply are additional factors that increase morbidity and mortality.
614:
ligation. Bilateral ligation of the internal iliac arteries reduces the pulse pressure of blood flowing to the uterus similar to uterine artery ligation. However, it is not a common procedure because of the degree of difficulty and
2501:
296:. The blood vessels that provide the blood supply to the placenta pass through this muscle. After labor it is the contraction of these muscles that physically squeeze the blood vessels so that
2494:
276:. Cesarean delivery, especially after prolonged labor, may cause the muscles of the uterus to become tired and stop contracting or contraction can be inhibited at the surgical site.
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3198:
1627:
Gallos ID, Williams HM, Price M, Merriel A, Gee H, Lissauer D, Moorthy V, Tobias A, Deeks JJ, Widmer M, Tunçalp Ö (2018-04-25). Cochrane
Pregnancy and Childbirth Group (ed.).
516:
and compression should be maintained, while drugs are administered. An intravenous catheter should also be started to administer fluids, medications, and blood products
320:
is commonly used to determine excessive blood loss. It is easy to underestimate maternal blood loss because the primary method of assessment is visual observation.
2752:
1532:
El Senoun GA, Singh M, Mousa HA, Alfirevic Z (November 2011). "Update on the new modalities on the prevention and management of postpartum haemorrhage".
368:
554:) Highly effective but it is expensive. It can cause bronchospasm and it should be avoided in asthmatics. May cause diarrhea, fevers, or tachycardia.
3094:
354:
and rapid identification of obstetric lacerations, helps exclude other causes of PPH. Laboratory tests can be drawn if coagulopathies are suspected.
2244:
367:
Before delivery all patients should be screened for risk factors and then assigned a postpartum hemorrhage risk stratification based on the
2088:"Novel suction tube uterine tamponade for treating intractable postpartum haemorrhage: description of technique and report of three cases"
1454:
Begley CM, Gyte GM, Devane D, McGuire W, Weeks A, Biesty LM, et al. (The
Cochrane Collaboration) (February 2019). Begley CM (ed.).
284:
Uterine atony occurs during 1 in 40 births in the United States and is responsible for at least 80% of cases of postpartum hemorrhage.
242:
can also lead to decreased uterine function and atony. Retained placental tissue or placental disorders, such as an adherent placenta,
2282:
Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF (April 2006). "WHO analysis of causes of maternal death: a systematic review".
791:
Mousa HA, Blum J, Abou El Senoun G, Shakur H, Alfirevic Z, et al. (Cochrane
Pregnancy and Childbirth Group) (February 2014).
1949:"Uterine flexion suture: modified B-Lynch uterine compression suture for the treatment of uterine atony during cesarean section"
512:
If uterine atony occurs even after all preventative measures have been taken, medical management should be implemented. Uterine
641:
273:
72:
2732:
2699:
840:
Breathnach F, Geary M (April 2009). "Uterine atony: definition, prevention, nonsurgical management, and uterine tamponade".
350:
imaging for rapid visualization of the uterus and other causes of bleeding. Expulsion of gestational products such as the
3220:
652:
1090:"Oxytocin during labour and risk of severe postpartum haemorrhage: a population-based, cohort-nested case-control study"
2747:
496:, such as oxytocin, prophylactically will help reduce blood loss and the need for a blood transfusion after delivery.
3150:
3005:
2932:
2627:
2039:"Bakri balloon placement in the successful management of postpartum hemorrhage in a bicornuate uterus: A case report"
986:"Bakri balloon placement in the successful management of postpartum hemorrhage in a bicornuate uterus: A case report"
312:
The uterus can also be structurally damaged or distended to prevent contraction. Therefore, as placenta is delivered
3177:
2798:
2536:
2198:"Bilateral uterine artery ligation plus B-Lynch procedure for atonic postpartum hemorrhage with placenta accreta"
268:, can inadvertently inhibit uterine contractions. In addition, preeclampsia can lead to blood disorders such as
257:
2679:
2881:
3165:
2948:
2793:
2197:
2961:
2479:
3072:
2871:
2845:
2581:
2527:
3109:
3099:
3017:
2917:
1234:
1146:
231:
213:, as the vasculature is not being sufficiently compressed. Uterine atony is the most common cause of
1504:"WHO recommendation on the use of uterine massage for the treatment of postpartum haemorrhage | RHL"
2635:
2440:
1328:"Obstetric Hemorrhage Outcomes by Intrapartum Risk Stratification at a Single Tertiary Care Center"
671:
Women with a history of PPH have a 2 to 3 times higher risk of PPH in their following pregnancies.
2087:
3034:
2956:
2714:
2383:
1999:
1802:
1763:
1677:
1575:
McDonald S, Abbott JM, Higgins SP, et al. (Cochrane
Pregnancy and Childbirth Group) (2004).
880:"Risk factors for uterine atony/postpartum hemorrhage requiring treatment after vaginal delivery"
66:
3155:
3129:
2907:
2727:
2722:
2694:
2671:
2571:
372:
116:
101:
Obesity, uterine distention, placental disorders, multiple gestation, prior PPH, coagulopathies
1998:
Dahlke JD, Mendez-Figueroa H, Maggio L, Hauspurg AK, Sperling JD, Chauhan S, Rouse DJ (2015).
3119:
3114:
2566:
611:
528:
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the hospital or facility to provide an appropriate level of care if any complications occur.
1088:
Belghiti K, Kayem G, Dupont C, Rudigoz RC, Bouvier-Colle MH, Deneux-Tharaux C (2011-12-21).
3124:
2993:
2888:
2709:
2684:
2000:"Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines"
334:
300:
can occur after the delivery of the fetus and the placenta. Local hemostatic factors like
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post-delivery. An atonic uterus can feel soft, "boggy" and/or enlarged. Bleeding from the
8:
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3104:
2998:
2927:
2912:
2893:
2742:
2556:
488:
247:
214:
193:
61:
Uncontrolled postpartum bleeding, decreased heart rate, pain, soft non-contracted uterus
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3089:
3064:
3029:
2876:
2866:
2561:
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2326:
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2063:
2038:
1975:
1948:
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1874:
1841:
1653:
1628:
1601:
1576:
1557:
1480:
1455:
1354:
1327:
1303:
1274:"The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries"
1210:
1185:
1122:
1089:
1062:
1037:
1010:
985:
961:
936:
912:
879:
817:
792:
56:
2295:
2196:
Shahin AY, Farghaly TA, Mohamed SA, Shokry M, Abd-El-Aal DE, Youssef MA (March 2010).
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2901:
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2519:
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2019:
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1015:
966:
948:
917:
899:
857:
822:
740:
636:
540:
106:
44:
2327:"Patterns of recurrence of postpartum hemorrhage in a large population-based cohort"
2142:
1930:
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1307:
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2354:
2338:
2311:
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2229:
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2011:
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1814:
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568:
561:
269:
243:
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Uterine massage, Oxytocin, uterotonics, tamponade or packing, surgical intervention
2399:
1898:
1840:
Butwick AJ, Carvalho B, Blumenfeld YJ, El-Sayed YY, Nelson LM, Bateman BT (2015).
1629:"Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis"
1186:"What measured blood loss tells us about postpartum bleeding: a systematic review"
853:
3077:
3044:
2833:
2818:
2598:
2445:
2158:
1779:
1577:"Prophylactic ergometrine-oxytocin versus oxytocin for the third stage of labour"
1290:
1273:
1038:"A flux of the reds: evolution of active management of the third stage of labour"
235:
129:
Risk stratification and identification, active management of third stage of labor
2054:
1105:
1001:
732:
307:
This physiological contraction does not occur if the myometrium becomes atonic.
3172:
3082:
2978:
2838:
2827:
2767:
2645:
2456:
2342:
2213:
2015:
1914:
1857:
1693:
1390:
1250:
1235:"Visually estimated and calculated blood loss in vaginal and cesarean delivery"
1053:
895:
761:
596:
513:
376:
342:
227:
1545:
1471:
520:
include oxytocin plus misoprostol, oxytocin plus ergometrine, and carbetocin.
316:
are damaged and without the muscle contractions hemostasis cannot be reached.
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2757:
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1865:
1740:
1553:
1429:
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952:
903:
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261:
91:
trauma, complicated labor, medications, uterine distention, caesarean section
2103:
1764:"Prevention of postpartum haemorrhage with the oxytocin analogue carbetocin"
3049:
2983:
2407:
2368:
2303:
2221:
2174:
2119:
2072:
2023:
1984:
1922:
1883:
1826:
1787:
1748:
1701:
1662:
1610:
1489:
1456:"Active versus expectant management for women in the third stage of labour"
1437:
1413:
1398:
1363:
1299:
1258:
1219:
1170:
1131:
1071:
1019:
970:
921:
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826:
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618:
251:
172:
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2737:
2689:
2622:
2603:
2588:
1965:
878:
Wetta LA, Szychowski JM, Seals S, Mancuso MS, Biggio JR, Tita AT (2013).
557:
341:
is also common. If the atony is localized to one area of the uterus, the
168:
96:
2432:
1807:
European
Journal of Obstetrics & Gynecology and Reproductive Biology
1768:
European
Journal of Obstetrics & Gynecology and Reproductive Biology
1344:
2608:
2515:
2325:
Oberg AS, Hernandez-Diaz S, Palmsten K, Almqvist C, Bateman BT (2014).
551:
547:
534:
493:
347:
297:
293:
292:
The uterus is composed of an interconnected muscle fibers known as the
250:
increase the mother's risk of PPH. Body mass index (BMI) above 40 and
210:
164:
156:
152:
142:
49:
1842:"Second-line uterotonics and the risk of hemorrhage-related morbidity"
2652:
2511:
2462:
601:
579:
265:
179:
935:
Ciobanu AM, Colibaba S, Cimpoca B, Peltecu G, Panaitescu AM (2016).
2546:
2324:
1997:
1377:
McDonald S (2007-05-01). "Management of the third stage of labor".
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recommendations. If the woman is at a medium risk, blood should be
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308:
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and platelets and clotting factors aid in stopping the blood flow.
160:
31:
2851:
1839:
1184:
Sloan NL, Durocher J, Aldrich T, Blum J, Winikoff B (June 2010).
148:
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206:
2092:
75:, hypovolemic shock, renal failure, hepatic failure, and death
2814:
2785:
2618:
1897:
Alfirevic Z, Blum J, Walraven G, Weeks A, Winikoff B (2007).
1326:
Hussain SA, Guarini CB, Blosser C, Poole AT (December 2019).
934:
790:
760:
Text was copied from this source, which is available under a
756:
2753:
Pruritic urticarial papules and plaques of pregnancy (PUPPP)
1800:
1531:
1233:
Stafford I, Dildy GA, Clark SL, Belfort MA (November 2008).
2384:"Postpartum hemorrhage: a recurring pregnancy complication"
2195:
1466:(2). Chichester, UK: John Wiley & Sons, Ltd: CD007412.
877:
1896:
1626:
1381:. Special Continuing Education Issue on Intrapartum Care.
1325:
1087:
571:(Prostin E2): An alternative prostaglandin to misoprostol.
1271:
1232:
2281:
1272:
Bateman BT, Berman MF, Riley LE, Leffert LR (May 2010).
1183:
1453:
2245:"Hypogastric Artery Ligation for Obstetric Hemorrhage"
2243:
Clark SL, Phelan JP, Yeh S, Bruce SR, Paul RH (1985).
2085:
1946:
1899:"Prevention of postpartum hemorrhage with misoprostol"
1678:"The use of uterotonic drugs during caesarean section"
762:
Creative
Commons Attribution 4.0 International License
629:
PPH can cause a multitude of complications including:
1574:
2422:
2381:
1903:
International
Journal of Gynecology & Obstetrics
1414:"Prevention and management of postpartum hemorrhage"
1147:"Uterine emergencies. Atony, inversion, and rupture"
302:
tissue factor type-1 plasminogen activator inhibitor
2242:
2202:
International
Journal of Gynaecology and Obstetrics
1942:
1940:
492:provider preference. It is suggested that using an
383:Postpartum hemorrhage risk stratification criteria
369:
American College of Obstetricians and Gynecologists
1801:den Hertog CE, de Groot AN, van Dongen PW (2001).
1675:
1151:Obstetrics and Gynecology Clinics of North America
3095:Childbirth-related post-traumatic stress disorder
730:
3212:
1937:
523:Medications used for PPH include the following:
2140:
839:
739:. Treasure Island (FL): StatPearls Publishing.
1411:
1083:
1081:
793:"Treatment for primary postpartum haemorrhage"
2495:
2331:American Journal of Obstetrics and Gynecology
2143:"Surgical Remedies for Postpartum Hemorrhage"
2043:International Journal of Surgery Case Reports
2004:American Journal of Obstetrics and Gynecology
1846:American Journal of Obstetrics and Gynecology
1717:"Pharmacology of Oxytocin and Prostaglandins"
1682:International Journal of Obstetric Anesthesia
1239:American Journal of Obstetrics and Gynecology
990:International Journal of Surgery Case Reports
884:American Journal of Obstetrics and Gynecology
1581:The Cochrane Database of Systematic Reviews
1460:The Cochrane Database of Systematic Reviews
1078:
797:The Cochrane Database of Systematic Reviews
375:. Those assessed to be high risk should be
357:
323:
2502:
2488:
2382:Kominiarek MA, Kilpatrick SJ (June 2007).
30:
2358:
2062:
1974:
1964:
1873:
1652:
1600:
1479:
1379:Journal of Midwifery & Women's Health
1353:
1343:
1289:
1209:
1121:
1061:
1009:
960:
911:
816:
1376:
1042:Journal of the Royal Society of Medicine
608:other interventions are being attempted.
591:Surgical management techniques include:
2036:
1953:International Journal of Women's Health
1633:Cochrane Database of Systematic Reviews
1035:
983:
642:disseminated intravascular coagulopathy
121:uterine inversion, obstetric laceration
16:Loss of tone in the uterine musculature
3213:
1676:Dyer RA, van Dyk D, Dresner A (2010).
1144:
274:disseminated intravascular coagulation
2733:Intrahepatic cholestasis of pregnancy
2700:Intrahepatic cholestasis of pregnancy
2483:
2086:Hofmeyr G, Singata-Madliki M (2020).
1947:Songthamwat S, Songthamwat M (2018).
1714:
1622:
1620:
1449:
1447:
1321:
1319:
1317:
731:Gill P, Patel A, Van Hook JW (2020).
726:
724:
722:
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710:
708:
706:
704:
604:to remove retained placental products
111:Physical exam and observed blood loss
2799:Pregnancy-induced hypercoagulability
1761:
1412:Anderson JM, Etches D (2007-03-15).
1031:
1029:
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684:
653:adult respiratory distress syndrome
13:
2748:Pruritic folliculitis of pregnancy
2147:Clinical Obstetrics and Gynecology
1721:Clinical Obstetrics and Gynecology
1617:
1534:Fetal and Maternal Medicine Review
1444:
1314:
1177:
287:
14:
3232:
3006:Pain management during childbirth
2933:Twin-to-twin transfusion syndrome
2418:
1026:
868:
767:
681:
479:Magnesium sulfate administration
209:contraction can lead to an acute
3192:
3191:
3178:Sexual activity during pregnancy
2141:Porreco RP, Stettler RW (2010).
1733:10.1097/00003081-200009000-00006
1202:10.1111/j.1471-0528.2010.02567.x
755:
624:
595:Compression sutures such as the
2375:
2318:
2275:
2236:
2189:
2134:
2079:
2030:
1991:
1890:
1833:
1794:
1755:
1708:
1669:
1568:
1525:
1496:
1405:
1370:
1265:
1226:
937:"Thrombocytopenia in Pregnancy"
279:
260:is used often in patients with
220:
39:Atonic uterus (held by surgeon)
2680:Acute fatty liver of pregnancy
1803:"History and use of oxytocics"
1645:10.1002/14651858.CD011689.pub2
1593:10.1002/14651858.CD000201.pub2
1138:
977:
928:
833:
809:10.1002/14651858.CD003249.pub3
272:, platelet abnormalities, and
1:
2882:Prelabor rupture of membranes
2400:10.1053/j.semperi.2007.03.001
2296:10.1016/S0140-6736(06)68397-9
1819:10.1016/S0301-2115(00)00311-0
1163:10.1016/S0889-8545(05)70087-5
1036:Baskett TF (September 2000).
854:10.1053/j.semperi.2008.12.001
674:
362:
3161:Systemic lupus erythematosus
2812:Maternal care related to the
2794:Gestational thrombocytopenia
2159:10.1097/GRF.0b013e3181cc4139
1780:10.1016/j.ejogrb.2009.06.018
1291:10.1213/ANE.0b013e3181d74898
1145:Ripley DL (September 1999).
666:
507:
472:Oxytocin longer than 24 hrs
184:2-3 times risk of recurrence
7:
2962:Cephalopelvic disproportion
2249:Obstetrics & Gynecology
2055:10.1016/j.ijscr.2017.01.055
1106:10.1136/bmjopen-2011-000514
1002:10.1016/j.ijscr.2017.01.055
10:
3237:
3221:Health issues in pregnancy
3073:Breastfeeding difficulties
2872:Constriction ring syndrome
2846:Braxton Hicks contractions
2343:10.1016/j.ajog.2013.10.872
2214:10.1016/j.ijgo.2009.08.035
2016:10.1016/j.ajog.2015.02.023
1915:10.1016/j.ijgo.2007.09.012
1858:10.1016/j.ajog.2015.01.008
1694:10.1016/j.ijoa.2010.04.011
1391:10.1016/j.jmwh.2007.02.012
1251:10.1016/j.ajog.2008.04.049
1054:10.1177/014107680009300913
896:10.1016/j.ajog.2013.03.011
465:Prolonged 2nd stage labor
3186:
3143:
3110:Peripartum cardiomyopathy
3100:Pubic symphysis diastasis
3063:
2947:
2811:
2784:
2766:
2708:
2670:
2661:
2617:
2535:
2526:
2426:
1546:10.1017/S0965539511000143
1472:10.1002/14651858.cd007412
1418:American Family Physician
487:Active management of the
188:
178:
141:
133:
125:
115:
105:
95:
87:
79:
65:
55:
43:
38:
29:
24:
2636:Gestational hypertension
2388:Seminars in Perinatology
1278:Anesthesia and Analgesia
984:Abraham C (2017-01-24).
842:Seminars in Perinatology
560:(Cytotec): A synthetic
423:≥ 2 medium risk factors
358:Treatment and management
324:Evaluation and diagnosis
254:are known risk factors.
226:than one fetus present,
3035:Umbilical cord prolapse
2957:Amniotic fluid embolism
2715:dermatoses of pregnancy
2104:10.1111/1471-0528.16169
562:prostaglandin E1 analog
377:typed and cross-matched
71:postpartum hemorrhage,
3151:Concomitant conditions
3130:Postpartum thyroiditis
2908:Circumvallate placenta
2728:Impetigo herpetiformis
2723:Gestational pemphigoid
2695:Hyperemesis gravidarum
2628:hypertensive disorders
546:15-methyl-PGF2-alpha (
431:Platelets < 70,000
396:Prior uterine surgery
117:Differential diagnosis
3120:Postpartum infections
3115:Postpartum depression
215:postpartum hemorrhage
3125:Postpartum psychosis
2994:Obstetrical bleeding
2889:Obstetrical bleeding
2710:Integumentary system
2685:Gestational diabetes
2664:related to pregnancy
2662:Other, predominantly
1966:10.2147/IJWH.S170460
504:to help hemostasis.
489:third stage of labor
335:bimanual examination
83:third stage of labor
3105:Postpartum bleeding
2928:Placental abruption
2913:Monochorionic twins
2743:Prurigo gestationis
2290:(9516): 1066–1074.
2010:(1): 76.e1–76.e10.
1345:10.7759/cureus.6456
439:Known coagulopathy
412:Grand multi-parity
404:Multiple gestation
384:
248:abruption placentae
194:postpartum bleeding
3135:Puerperal mastitis
3090:Breast engorgement
2877:Monoamniotic twins
2867:Chorionic hematoma
2037:Abraham C (2017).
1514:on October 3, 2020
1157:(3): 419–34, vii.
612:Hypogastric artery
382:
373:typed and screened
3208:
3207:
3166:Thyroid disorders
3156:Diabetes mellitus
3040:Uterine inversion
2972:Shoulder dystocia
2967:Obstructed labour
2943:
2942:
2807:
2806:
2776:Chorea gravidarum
2552:Ectopic pregnancy
2477:
2476:
2098:(10): 1280–1283.
637:hypovolemic shock
602:Uterine curettage
485:
484:
458:Chorioamnionitis
407:Placenta accrete
258:Magnesium sulfate
199:
198:
107:Diagnostic method
19:Medical condition
3228:
3195:
3194:
3030:Postmature birth
3018:Placenta accreta
2923:Placenta praevia
2918:Placenta accreta
2862:Chorioamnionitis
2672:Digestive system
2668:
2667:
2594:Fetal resorption
2582:Rudimentary horn
2539:abortive outcome
2533:
2532:
2504:
2497:
2490:
2481:
2480:
2424:
2423:
2412:
2411:
2379:
2373:
2372:
2362:
2322:
2316:
2315:
2279:
2273:
2272:
2240:
2234:
2233:
2193:
2187:
2186:
2138:
2132:
2131:
2083:
2077:
2076:
2066:
2034:
2028:
2027:
1995:
1989:
1988:
1978:
1968:
1944:
1935:
1934:
1894:
1888:
1887:
1877:
1837:
1831:
1830:
1798:
1792:
1791:
1759:
1753:
1752:
1715:Arias F (2000).
1712:
1706:
1705:
1673:
1667:
1666:
1656:
1624:
1615:
1614:
1604:
1572:
1566:
1565:
1529:
1523:
1522:
1520:
1519:
1510:. Archived from
1508:extranet.who.int
1500:
1494:
1493:
1483:
1451:
1442:
1441:
1409:
1403:
1402:
1374:
1368:
1367:
1357:
1347:
1323:
1312:
1311:
1293:
1269:
1263:
1262:
1230:
1224:
1223:
1213:
1181:
1175:
1174:
1142:
1136:
1135:
1125:
1085:
1076:
1075:
1065:
1033:
1024:
1023:
1013:
981:
975:
974:
964:
932:
926:
925:
915:
875:
866:
865:
837:
831:
830:
820:
788:
765:
759:
754:
752:
751:
728:
541:Methylergonovine
415:Active bleeding
399:Placenta Previa
385:
381:
270:thrombocytopenia
240:chorioamnionitis
236:uterine fibroids
232:fetal macrosomia
34:
22:
21:
3236:
3235:
3231:
3230:
3229:
3227:
3226:
3225:
3211:
3210:
3209:
3204:
3182:
3139:
3083:Cracked nipples
3078:Low milk supply
3059:
3045:Uterine rupture
2939:
2834:Oligohydramnios
2819:amniotic cavity
2813:
2803:
2780:
2762:
2713:
2704:
2663:
2657:
2626:
2613:
2599:Molar pregnancy
2538:
2522:
2508:
2478:
2473:
2472:
2435:
2421:
2416:
2415:
2380:
2376:
2337:(3): 229.e1–8.
2323:
2319:
2280:
2276:
2241:
2237:
2194:
2190:
2139:
2135:
2084:
2080:
2035:
2031:
1996:
1992:
1945:
1938:
1895:
1891:
1852:(5): 642.e1–7.
1838:
1834:
1799:
1795:
1762:Rath W (2009).
1760:
1756:
1713:
1709:
1674:
1670:
1639:(4): CD011689.
1625:
1618:
1587:(1): CD000201.
1573:
1569:
1530:
1526:
1517:
1515:
1502:
1501:
1497:
1452:
1445:
1410:
1406:
1375:
1371:
1324:
1315:
1270:
1266:
1245:(5): 519.e1–7.
1231:
1227:
1182:
1178:
1143:
1139:
1086:
1079:
1034:
1027:
982:
978:
933:
929:
876:
869:
838:
834:
803:(2): CD003249.
789:
768:
749:
747:
733:"Uterine Atony"
729:
682:
677:
669:
649:hepatic failure
627:
510:
428:Large fibroids
365:
360:
326:
290:
288:Pathophysiology
282:
244:placenta previa
223:
20:
17:
12:
11:
5:
3234:
3224:
3223:
3206:
3205:
3203:
3202:
3187:
3184:
3183:
3181:
3180:
3175:
3173:Maternal death
3170:
3169:
3168:
3163:
3158:
3147:
3145:
3141:
3140:
3138:
3137:
3132:
3127:
3122:
3117:
3112:
3107:
3102:
3097:
3092:
3087:
3086:
3085:
3080:
3069:
3067:
3061:
3060:
3058:
3057:
3052:
3047:
3042:
3037:
3032:
3027:
3022:
3021:
3020:
3008:
3003:
3002:
3001:
2991:
2986:
2981:
2979:Fetal distress
2976:
2975:
2974:
2964:
2959:
2953:
2951:
2945:
2944:
2941:
2940:
2938:
2937:
2936:
2935:
2930:
2925:
2920:
2915:
2910:
2898:
2897:
2896:
2886:
2885:
2884:
2879:
2874:
2869:
2864:
2848:
2843:
2842:
2841:
2839:Polyhydramnios
2836:
2828:amniotic fluid
2823:
2821:
2809:
2808:
2805:
2804:
2802:
2801:
2796:
2790:
2788:
2782:
2781:
2779:
2778:
2772:
2770:
2768:Nervous system
2764:
2763:
2761:
2760:
2755:
2750:
2745:
2740:
2735:
2730:
2725:
2719:
2717:
2706:
2705:
2703:
2702:
2697:
2692:
2687:
2682:
2676:
2674:
2665:
2659:
2658:
2656:
2655:
2650:
2649:
2648:
2646:HELLP syndrome
2638:
2632:
2630:
2615:
2614:
2612:
2611:
2606:
2601:
2596:
2591:
2586:
2585:
2584:
2579:
2574:
2569:
2564:
2559:
2549:
2543:
2541:
2537:Pregnancy with
2530:
2524:
2523:
2507:
2506:
2499:
2492:
2484:
2475:
2474:
2471:
2470:
2459:
2448:
2436:
2431:
2430:
2428:
2427:Classification
2420:
2419:External links
2417:
2414:
2413:
2374:
2317:
2274:
2255:(3): 353–356.
2235:
2188:
2153:(1): 182–195.
2133:
2078:
2029:
1990:
1936:
1889:
1832:
1793:
1754:
1727:(3): 455–468.
1707:
1688:(3): 313–319.
1668:
1616:
1567:
1540:(4): 247–264.
1524:
1495:
1443:
1424:(6): 875–882.
1404:
1369:
1313:
1284:(5): 1368–73.
1264:
1225:
1196:(7): 788–800.
1176:
1137:
1100:(2): e000514.
1077:
1025:
976:
927:
890:(1): 51.e1–6.
867:
832:
766:
679:
678:
676:
673:
668:
665:
656:
655:
650:
647:
644:
639:
634:
626:
623:
622:
621:
616:
609:
605:
599:
573:
572:
566:
555:
544:
538:
532:
514:fundal massage
509:
506:
502:prostaglandins
483:
482:
480:
476:
475:
473:
469:
468:
466:
462:
461:
459:
455:
454:
452:
448:
447:
445:
441:
440:
437:
433:
432:
429:
425:
424:
421:
417:
416:
413:
409:
408:
405:
401:
400:
397:
393:
392:
389:
364:
361:
359:
356:
325:
322:
289:
286:
281:
278:
252:coagulopathies
228:polyhydramnios
222:
219:
197:
196:
190:
186:
185:
182:
176:
175:
145:
139:
138:
135:
131:
130:
127:
123:
122:
119:
113:
112:
109:
103:
102:
99:
93:
92:
89:
85:
84:
81:
77:
76:
69:
63:
62:
59:
53:
52:
47:
41:
40:
36:
35:
27:
26:
18:
15:
9:
6:
4:
3:
2:
3233:
3222:
3219:
3218:
3216:
3201:
3200:
3196:
3189:
3188:
3185:
3179:
3176:
3174:
3171:
3167:
3164:
3162:
3159:
3157:
3154:
3153:
3152:
3149:
3148:
3146:
3142:
3136:
3133:
3131:
3128:
3126:
3123:
3121:
3118:
3116:
3113:
3111:
3108:
3106:
3103:
3101:
3098:
3096:
3093:
3091:
3088:
3084:
3081:
3079:
3076:
3075:
3074:
3071:
3070:
3068:
3066:
3062:
3056:
3055:Uterine atony
3053:
3051:
3048:
3046:
3043:
3041:
3038:
3036:
3033:
3031:
3028:
3026:
3025:Preterm birth
3023:
3019:
3016:
3015:
3014:
3013:
3009:
3007:
3004:
3000:
2997:
2996:
2995:
2992:
2990:
2987:
2985:
2982:
2980:
2977:
2973:
2970:
2969:
2968:
2965:
2963:
2960:
2958:
2955:
2954:
2952:
2950:
2946:
2934:
2931:
2929:
2926:
2924:
2921:
2919:
2916:
2914:
2911:
2909:
2906:
2905:
2904:
2903:
2899:
2895:
2892:
2891:
2890:
2887:
2883:
2880:
2878:
2875:
2873:
2870:
2868:
2865:
2863:
2860:
2859:
2858:
2857:
2853:
2849:
2847:
2844:
2840:
2837:
2835:
2832:
2831:
2830:
2829:
2825:
2824:
2822:
2820:
2816:
2810:
2800:
2797:
2795:
2792:
2791:
2789:
2787:
2783:
2777:
2774:
2773:
2771:
2769:
2765:
2759:
2758:Stretch marks
2756:
2754:
2751:
2749:
2746:
2744:
2741:
2739:
2736:
2734:
2731:
2729:
2726:
2724:
2721:
2720:
2718:
2716:
2711:
2707:
2701:
2698:
2696:
2693:
2691:
2688:
2686:
2683:
2681:
2678:
2677:
2675:
2673:
2669:
2666:
2660:
2654:
2651:
2647:
2644:
2643:
2642:
2641:Pre-eclampsia
2639:
2637:
2634:
2633:
2631:
2629:
2624:
2620:
2616:
2610:
2607:
2605:
2602:
2600:
2597:
2595:
2592:
2590:
2587:
2583:
2580:
2578:
2575:
2573:
2570:
2568:
2565:
2563:
2560:
2558:
2555:
2554:
2553:
2550:
2548:
2545:
2544:
2542:
2540:
2534:
2531:
2529:
2525:
2521:
2517:
2513:
2510:Pathology of
2505:
2500:
2498:
2493:
2491:
2486:
2485:
2482:
2469:
2465:
2464:
2460:
2458:
2454:
2453:
2449:
2447:
2443:
2442:
2438:
2437:
2434:
2429:
2425:
2409:
2405:
2401:
2397:
2394:(3): 159–66.
2393:
2389:
2385:
2378:
2370:
2366:
2361:
2356:
2352:
2348:
2344:
2340:
2336:
2332:
2328:
2321:
2313:
2309:
2305:
2301:
2297:
2293:
2289:
2285:
2278:
2270:
2266:
2262:
2258:
2254:
2250:
2246:
2239:
2231:
2227:
2223:
2219:
2215:
2211:
2208:(3): 187–90.
2207:
2203:
2199:
2192:
2184:
2180:
2176:
2172:
2168:
2164:
2160:
2156:
2152:
2148:
2144:
2137:
2129:
2125:
2121:
2117:
2113:
2109:
2105:
2101:
2097:
2093:
2089:
2082:
2074:
2070:
2065:
2060:
2056:
2052:
2048:
2044:
2040:
2033:
2025:
2021:
2017:
2013:
2009:
2005:
2001:
1994:
1986:
1982:
1977:
1972:
1967:
1962:
1958:
1954:
1950:
1943:
1941:
1932:
1928:
1924:
1920:
1916:
1912:
1909:: S198–S201.
1908:
1904:
1900:
1893:
1885:
1881:
1876:
1871:
1867:
1863:
1859:
1855:
1851:
1847:
1843:
1836:
1828:
1824:
1820:
1816:
1812:
1808:
1804:
1797:
1789:
1785:
1781:
1777:
1773:
1769:
1765:
1758:
1750:
1746:
1742:
1738:
1734:
1730:
1726:
1722:
1718:
1711:
1703:
1699:
1695:
1691:
1687:
1683:
1679:
1672:
1664:
1660:
1655:
1650:
1646:
1642:
1638:
1634:
1630:
1623:
1621:
1612:
1608:
1603:
1598:
1594:
1590:
1586:
1582:
1578:
1571:
1563:
1559:
1555:
1551:
1547:
1543:
1539:
1535:
1528:
1513:
1509:
1505:
1499:
1491:
1487:
1482:
1477:
1473:
1469:
1465:
1461:
1457:
1450:
1448:
1439:
1435:
1431:
1427:
1423:
1419:
1415:
1408:
1400:
1396:
1392:
1388:
1385:(3): 254–61.
1384:
1380:
1373:
1365:
1361:
1356:
1351:
1346:
1341:
1338:(12): e6456.
1337:
1333:
1329:
1322:
1320:
1318:
1309:
1305:
1301:
1297:
1292:
1287:
1283:
1279:
1275:
1268:
1260:
1256:
1252:
1248:
1244:
1240:
1236:
1229:
1221:
1217:
1212:
1207:
1203:
1199:
1195:
1191:
1187:
1180:
1172:
1168:
1164:
1160:
1156:
1152:
1148:
1141:
1133:
1129:
1124:
1119:
1115:
1111:
1107:
1103:
1099:
1095:
1091:
1084:
1082:
1073:
1069:
1064:
1059:
1055:
1051:
1048:(9): 489–93.
1047:
1043:
1039:
1032:
1030:
1021:
1017:
1012:
1007:
1003:
999:
995:
991:
987:
980:
972:
968:
963:
958:
954:
950:
946:
942:
938:
931:
923:
919:
914:
909:
905:
901:
897:
893:
889:
885:
881:
874:
872:
863:
859:
855:
851:
847:
843:
836:
828:
824:
819:
814:
810:
806:
802:
798:
794:
787:
785:
783:
781:
779:
777:
775:
773:
771:
763:
758:
746:
742:
738:
734:
727:
725:
723:
721:
719:
717:
715:
713:
711:
709:
707:
705:
703:
701:
699:
697:
695:
693:
691:
689:
687:
685:
680:
672:
664:
660:
654:
651:
648:
646:renal failure
645:
643:
640:
638:
635:
632:
631:
630:
625:Complications
620:
617:
613:
610:
606:
603:
600:
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25:Uterine atony
23:
3197:
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3054:
3050:Vasa praevia
3010:
2984:Locked twins
2900:
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2572:Interstitial
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1774:(1): 15–20.
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1516:. Retrieved
1512:the original
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628:
619:Hysterectomy
590:
578:
574:
569:Dinoprostone
522:
518:
511:
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486:
388:Medium Risk
366:
331:
327:
318:
306:
291:
283:
280:Epidemiology
262:preeclampsia
256:
224:
221:Risk factors
201:
200:
173:Dinoprostone
97:Risk factors
2989:Nuchal cord
2738:Linea nigra
2690:Hepatitis E
2623:proteinuria
2604:Miscarriage
2589:Embryo loss
2567:Heterotopic
2049:: 218–220.
1959:: 487–492.
1813:(1): 8–12.
996:: 218–220.
848:(2): 82–7.
558:Misoprostol
444:BMI >40
436:Macrosomia
339:cervical os
169:Misoprostol
80:Usual onset
2999:Postpartum
2894:Antepartum
2609:Stillbirth
2520:puerperium
2518:, and the
2516:childbirth
2452:DiseasesDB
1518:2020-10-20
750:2020-10-19
737:StatPearls
675:References
552:Carboprost
535:Carbetocin
527:Oxytocin (
494:uterotonic
420:Prior PPH
391:High Risk
363:Prevention
348:ultrasound
298:hemostasis
294:myometrium
211:hemorrhage
165:Carboprost
157:Methergine
153:Carbetocin
147:Oxytocin (
143:Medication
126:Prevention
50:Obstetrics
3065:Puerperal
2653:Eclampsia
2557:Abdominal
2528:Pregnancy
2512:pregnancy
2463:SNOMED CT
2351:1097-6868
2261:0029-7844
2167:0009-9201
2128:211079411
2112:1470-0328
1866:1097-6868
1741:0009-9201
1554:0965-5395
1430:0002-838X
1114:2044-6055
953:1841-9038
904:1097-6868
667:Prognosis
580:Tamponade
508:Treatment
266:eclampsia
189:Frequency
180:Prognosis
134:Treatment
45:Specialty
3215:Category
3199:Category
3012:placenta
2902:placenta
2562:Cervical
2547:Abortion
2408:17531897
2369:24351791
2304:16581405
2222:19944417
2175:20142655
2120:32043686
2073:28189983
2024:25731692
1985:30197543
1931:45977576
1923:17961574
1884:25582104
1827:11134819
1788:19616358
1749:10949750
1702:20627531
1663:29693726
1611:14973949
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1490:30754073
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1364:32025387
1308:46459480
1300:20237047
1259:18639209
1220:20406227
1171:10472062
1132:22189353
1094:BMJ Open
1072:11089490
1020:28189983
971:28465752
922:23507549
862:19324236
827:24523225
745:29630290
548:Hemabate
352:placenta
314:arteries
309:Oxytocin
161:Hemabate
57:Symptoms
2852:chorion
2577:Ovarian
2468:9293002
2446:D014593
2360:3943527
2312:2190885
2269:3875064
2230:9565057
2183:1501779
2064:5302184
1976:6113941
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1123:3334825
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1011:5302184
962:5394486
941:Maedica
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818:6483801
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529:Pitocin
451:Anemia
192:80% of
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2179:S2CID
2124:S2CID
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1558:S2CID
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633:death
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1659:PMID
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1585:2018
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1395:PMID
1360:PMID
1296:PMID
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1216:PMID
1190:BJOG
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823:PMID
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