Dear Colleagues,
Although there have been significant advances in the medical management of postpartum hemorrhage (PPH) over recent decades, which is reflected in numerous published guidelines, the incidence of PPH is continuously increasing due to the increase in uterine atony and placental implantation disorders as well as increasing rates of instrumental vaginal and caesarean section deliveries.
PPH, defined as loss of > 500 mL of blood within 24 hours after birth, is the leading cause of maternal mortality worldwide. It affects an estimated 14 million women each year and results in approximately 70 000 deaths – mostly in low- and middle-income countries - equivalent to 1 death every 6 minutes. Life-threatening postpartum hemorrhage affects approximately 2/1000 births in the Western world, in addition to severe maternal morbidity in approximately 3/1000 births. PPH is thus the cause of nearly 30% of all maternal deaths in low- and middle-income patients and in 13% in industrialized countries.
The majority of maternal deaths due to PPH are preventable and 60-80% of all cases are due to "major substandard care". To overcome this problem, every obstetric unit should have an interdisciplinary coordinated algorithm for the diagnosis and treatment of postpartum hemorrhage. In addition to general measures (e.g. for circulatory stabilization), treatment includes cause-adapted drug (uterotonics), uterine tamponade and/or surgical therapy, along with coagulation management, which must be carried out rapidly and simultaneously in a coordinated manner.
The aim of this special issue on PPH is to give a recent overview on the management of PPH, starting with risk stratification and early detection of women at high risk for PPH (such as placenta accreta spectrum), its prevention and timely diagnosis, as well as proper and timely initiation of treatment including new therapeutic strategies such as vacuum tamponade of the uterus.
Dr. Dietmar Schlembach
Guest Editor
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