ABSTRACT
The most common cause of postpartum haemorrhage (PPH) is an atonic uterus, but the following must also be considered: retained placenta; a tear of the vaginal wall or cervix; a vulval or paravaginal haematoma; a uterine scar rupture; diffuse intravascular coagulation; and amniotic fluid embolus. If PPH is major, the cause of the haemorrhage has to be treated and the patient made stable. If PPH is massive, the SHO, specialist registrar and anaesthetist should be called. If an atonic uterus is not found to be the cause of the PPH, the woman should be managed according to the advice of the senior specialist registrar and/or consultant. Staff should perform the following investigations in women who have been shown to have an atonic uterus: check that the placenta is complete and ensure that the woman’s bladder is empty.
