ABSTRACT
Postpartum hemorrhage (PPH) has been variously defined as excessive bleeding occurring in the first 24 hours after delivery, estimated blood loss of =500 mL after vaginal delivery and =1000 mL after cesarean, bleeding associated with a hematocrit drop of 10 percentage points, and need for transfusion and hemodynamic instability. The management of PPH includes two primary components: identifying and controlling the cause of the bleeding and assessing and stabilizing the hemodynamic status of the patient. A unique and challenging situation occurs for patients who decline blood products. These can present clinical, professional, ethical, and legal dilemmas that can be extremely difficult for the patient and the care team. Institutional policies should be developed for the management of these complex cases to provide guidance for care that will avoid the challenges of decision-making under high-stress circumstances.
