Postpartum Hemorrage

Postpartum hemorrhage (PPH) is one of the most common and serious obstetric emergencies and remains the leading cause of maternal mortality worldwide, particularly in low- and middle-income countries. It is traditionally defined as blood loss of 500 mL or more after vaginal delivery or 1000 mL or more following cesarean section, although modern definitions emphasize cumulative blood loss associated with signs of hypovolemia. The condition may be primary (within 24 hours of delivery) or secondary (24 hours to 6 weeks postpartum). The major causes are summarized by the “four Ts”: tone, trauma, tissue, and thrombin. Despite advances in obstetric care, PPH continues to pose a significant challenge due to its sudden onset and rapid progression. Effective management requires early recognition, prompt resuscitation, identification of the underlying cause, and coordinated multidisciplinary care. This article provides a comprehensive review of postpartum hemorrhage using the IMRAD structure, covering epidemiology, etiology, risk factors, clinical features, diagnostic approach, prevention strategies, and evidence-based management. Emphasis is placed on active management of the third stage of labor, use of uterotonic agents, surgical interventions, and global guidelines aimed at reducing maternal morbidity and mortality.