Postpartum Hemorrhage

• All obstetric care facilities should have guidelines for the routine administration of uterotonics in the immediate postpartum period.
• Uterotonic agents should be the first-line treatment for postpartum hemorrhage caused by uterine atony. The specific agent selected, outside of recognized contraindications, is at the health care provider’s discretion because none has been shown to have greater efficacy than others for the treatment of uterine atony.

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When uterotonics fail to adequately control postpartum hemorrhage, prompt escalation to other interventions (such as tamponade or surgical tech- niques) and escalation of intensity of care and support personnel are indicated. Given the mortality reduction findings, tranexamic acid should be considered in the setting of obstetric hemorrhage when initial medical therapy fails. Obstetrician–gynecologists and other obstetric care providers should work with their institutions to ensure the existence of a designated multidisciplinary response team, a staged postpartum hemorrhage protocol that includes guidelines for escalation of care, and a functioning massive transfusion protocol.