Emergent management of postpartum hemorrhage for the general and acute care surgeon

The purpose of this manuscript is to serve as a topic specific review for surgeons and to present a surgeon oriented management algorithm. Medline and Ovid databases were utilized in a comprehensive literature review regarding the management of postpartum hemorrhage and a management algorithm for surgeons developed based upon a collaborative panel of general, acute care, trauma and obstetrical surgeons' review of the literature and expert opinion.A stepwise approach for surgeons of the medical and surgical interventions utilized to manage and treat postpartum hemorrhage is presented and organized into a basic algorithm.The manuscript should promote and facilitate a more educated, systematic and effective surgeon response and participation in the management of postpartum hemorrhage.Postpartum hemorrhage (PPH) is one of the rare occasions when a general or acute care surgeon may be called to labor and delivery emergently. At the least, this represents entrance into an environment and scenario that for most surgeons is not only foreign but also one in which time is limited and the stakes high. Being prepared to competently participate in the management of severe postpartum hemorrhage necessitates a basic knowledge of pelvic and gynecologic anatomy, the pathophysiology of such hemorrhage and a conceptual algorithm for its management to permit integrated participation with the obstetrical team for efficient and efficacious care of the new mother.Postpartum hemorrhage may occur in 1-5% of deliveries in developed countries [1,2], and is still the most significant cause of maternal morbidity and mortality [3]. Blood loss following childbirth will vary depending on the type of delivery: vaginal versus cesarean. Classically, PPH has been defined as a blood loss greater than 500 mL after a vaginal delivery and greater than 1000 mL after a cesarean section. These definitions are flawed in that it is recognized that 500 mL is the average blood loss after a vaginal delivery and 1