What is the new ACOG PPH definition?

ACOG (2017) revised PPH definition to QBL ≥1000 mL or any blood loss with signs of hemodynamic instability, regardless of delivery mode. Prior definition was ≥500 mL vaginal and ≥1000 mL cesarean.

What causes most PPH?

Uterine atony is the leading cause (70-80%). The '4T' causes: Tone (atony), Trauma (lacerations), Tissue (retained placenta), Thrombin (coagulopathy). Sequential uterotonic and interventional approach guides management.

What blood component ratio is used in massive obstetric hemorrhage?

1:1:1 ratio of pRBC:FFP:platelets (or equivalent fibrinogen). High fibrinogen level at onset of PPH (>4 g/L) is protective. Fibrinogen <2 g/L predicts progression to severe PPH. Cryoprecipitate or fibrinogen concentrate for ≨1 g/L.

Obstetric Hemorrhage QBL and PPH Risk Score

Quantify intrapartum blood loss (QBL) and calculate postpartum hemorrhage (PPH) risk score. PPH defined as QBL ≥1000 mL or blood loss with signs of hemodynamic instability. Risk factors: uterine atony, placenta previa/accreta, coagulopathy.

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