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The first is a lack of experienced caregivers who might be able to successfully manage PPH if it occurred.Additionally, the same drugs used for prophylaxis against PPH in active management of the third stage are also the primary agents in the treatment of PPH.Data from several sources, including several large randomized trials performed in industrialized countries, indicate that the prevalence rate of PPH of more than 500 m L is approximately 5% when active management is used versus 13% when expectant management is used.
Deliveries at less than 20 weeks’ gestational age are spontaneous abortions.
Bleeding related to spontaneous abortion may have etiologies and management in common with those for PPH.
Uterine contraction and retraction leads to detachment and expulsion of the placenta.
Complete detachment and expulsion of the placenta permits continued retraction and optimal occlusion of blood vessels.
Although maternal mortality rates have declined greatly in the developed world, PPH remains a leading cause of maternal mortality elsewhere.
The pregnancy-related mortality ratio in the United States was 17.3 deaths per 100,000 live births in 2013.PPH has many potential causes, but the most common, by a wide margin, is uterine atony, ie, failure of the uterus to contract and retract following delivery of the baby.PPH in a previous pregnancy is a major risk factor and every effort should be made to determine its severity and cause.Lack of blood transfusion services, anesthetic services, and operating capabilities also plays a role.Finally, the previously mentioned comorbidities are more commonly observed in developing countries and combine to decrease a woman's tolerance of blood loss.Studies have suggested that caregivers consistently underestimate actual blood loss.Another proposal suggests using a 10% fall in hematocrit value to define PPH, but this change is dependent on the timing of the test and the amount of fluid resuscitation given.In the developing world, several countries have maternal mortality rates in excess of 1000 women per 100,000 live births, and World Health Organization statistics suggest that 60% of maternal deaths in developing countries are due to PPH, accounting for more than 100,000 maternal deaths per year.A loss of these amounts within 24 hours of delivery is termed early or primary PPH, whereas such losses are termed late or secondary PPH if they occur 24 hours after delivery. Estimates of blood loss at delivery are subjective and generally inaccurate.The frequency of PPH is related to the management of the third stage of labor.This is the period from the completed delivery of the baby until the completed delivery of the placenta.