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Am Fam Physician. 2023;107(4):438-440

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Key Points for Practice

• Oxytocin given between delivery of the infant and the placenta is the most effective intervention to prevent postpartum hemorrhage.

• Tranexamic acid given within three hours of vaginal delivery after 500 mL of blood loss reduces mortality by up to 30%.

• Uterine balloon tamponade prior to shock controls more than 80% of postpartum hemorrhage cases that do not respond to initial interventions, and it can confirm the uterus as the source of bleeding. 

• The nonpneumatic antishock garment provides lower body compression to increase cardiac function in postpartum hemorrhage, and it reduces maternal mortality by nearly one-half.

From the AFP Editors

Although definitions vary, the American College of Obstetricians and Gynecologists defines postpartum hemorrhage as blood loss of at least 1,000 mL or blood loss accompanied by signs of hypovolemia within 24 hours of delivery. Postpartum hemorrhage complicates up to 1 in 10 deliveries and is the leading cause of maternal morbidity and mortality worldwide. Despite many identified risk factors of postpartum hemorrhage, most cases occur unexpectedly. The International Federation of Gynecology and Obstetrics (FIGO) published new guidelines for the prevention and management of postpartum hemorrhage.

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Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, Assistant Medical Editor.

A collection of Practice Guidelines published in AFP is available at

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