ABSTRACT
The assessment of major obstetric haemorrhage can be made even more difficult by the presence of the numerous confounding factors that may have to be considered. Successive reports into maternal mortality have testified to the frightening speed with which obstetric haemorrhage can become life-threatening. Minor lacerations are common as a result of vaginal birth, but excessive maternal haemorrhage may be associated with delivery of a large infant relative to the mother’s size or a difficult instrumental delivery. Massive obstetric haemorrhage can be fatal before coagulation failure supervenes, but Disseminated intravascular coagulation may complicate some 10% of cases of placental abruption and 40% of cases of the much rarer condition of amniotic fluid embolism syndrome. The physiological compensatory responses described help to explain the clinical features that accompany major haemorrhage. Traumatic delivery of a large baby after prolonged labour, for example, may be complicated both by uterine atony and by lower genital tract trauma.
