Review: Overview of postpartum haemorrhage as a global problem and in South Africa

Abstract

Postpartum haemorrhage (PPH) is a major cause of maternal morbidity and mortality in under-resourced settings. It is also a major cause of severe acute morbidity in well-resourced settings. The maternal mortality ratio for PPH in South Africa in the years 2005-2007 was 18.8 deaths per 100,000 live births; there were 491 deaths in 3 years. It should be noted that although the known causes of PPH are uterine atony, genital tract trauma (including ruptured uteri), retained placenta inverted uterus, bleeding following abruptio placenta and placenta praevia, and maternal bleeding disorders, there can be more than 1 cause for PPH for an individual patient. All causes can be complicated by a coagulopathy which results from massive blood loss and PPH can occur at and after caesarean section. The majority of deaths attributed to PPH in South Africa were preventable. It is vital that all levels of health care can deal with the emergency management of PPH and are also aware of the preventable factors.