Review Article

Contemporary Approach to Postpartum Hemorrhage: Literature Review

Authors: Natalia Sofia Torres-Herrera, Yemileth Carolina Fernández López, Angie Sofia Sarmiento Herrera, Camilo Lopera-Martínez, Daniela López-Quintero, Yuliana Oyola-Chávez, Christian Javier Carcamo-Cardozo, Yuranis Paola Ruiz-Feria, Jhon Alexander Pérez-Sanmiguel, Talia Fernanda Muñiz-Vásquez, Man

DOI: 10.33425/2993-6799.1031

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Abstract

Obstetric haemorrhage—particularly primary postpartum haemorrhage—remains the leading preventable cause of maternal death worldwide. Despite pharmacological and surgical advances, its incidence remains high in low- and middle-income countries, where limited access to high-quality uterotonics, safe blood products, and multidisciplinary teams increases lethality. This article critically reviews the epidemiology, pathophysiology, and contemporary evidence-based diagnostic and treatment strategies published between 2000 and 2025. The Shock Index (≥ 0.9) is highlighted as an early marker of haemodynamic instability, and the importance of objective blood-loss quantification for activating rapid-response protocols is emphasised. Stepwise management integrates early haemostatic resuscitation, sequential and rational use of uterotonics, administration of tranexamic acid within the first three hours, intra-uterine tamponade, conservative surgical techniques, and—where available—selective arterial embolisation. A prevention bundle centred on active management of the third stage of labour with oxytocin or heat-stable carbetocin reduces postpartum haemorrhage incidence by more than 40 %. Disparities between high- and low-income countries demand systemic interventions that ensure supplies, train personnel, and optimise referral networks. Implementation of standardised obstetric bundles, together with wider availability of haemostatic technologies and universal access to heat-stable uterotonics, constitutes the most effective strategy for achieving the Sustainable Development Goal 2030 targets for maternal-mortality reduction.

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