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Postpartum Haemorrhage, Prevention and Management (Green-top Guideline No. 52)

Published: 11/05/2009

This is the first edition of this guideline, published in May 2009. Minor revisions were made in November 2009 and April 2011.

Update November 2014: This guideline is currently being revised, with publication anticipated early 2016. The version available on the website and app will remain valid until replaced.

Primary postpartum haemorrhage (PPH) is the most common form of major obstetric haemorrhage. The traditional definition of primary PPH is the loss of 500 ml or more of blood from the genital tract within 24 hours of the birth of a baby. PPH can be minor (500–1000 ml) or major (more than 1000 ml). Major could be divided to moderate (1000–2000 ml) or severe (more than 2000 ml). The recommendations in this guideline apply to women experiencing primary PPH of 500 ml or more.

Secondary PPH is defined as abnormal or excessive bleeding from the birth canal between 24 hours and 12 weeks postnatally. This guideline also includes recommendations specific to the management of major secondary PPH.

Women with pre-existing bleeding disorders such as haemophilia and women taking therapeutic anticoagulants are at increased risk of PPH; this guideline does not include specific recommendations for the management of such situations, nor for managing haemorrhage in women who refuse blood transfusion. Guidance on these topics is available from other sources.

This guideline has been developed primarily for clinicians working in consultant-led obstetric units in the UK; recommendations may be less appropriate for other settings where facilities, resources and routine practice differ.