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

Published: 16/12/2016

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

This guideline provides information about the prevention and management of postpartum haemorrhage (PPH), primarily for clinicians working in obstetric-led units in the UK; recommendations may be less appropriate for other settings where facilities, resources and routine practices differ.

You can also access this guideline as a PDF version

This is the second edition of this guideline, which was published in 2009 under the same title. The 2009 guideline was based on an earlier guideline on the management of PPH developed in 1998 under the auspices of the Scottish Committee of the Royal College of Obstetricians and Gynaecologists (RCOG) and updated in 2002.

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. 

Women with pre-existing bleeding disorders and women taking therapeutic anticoagulants are at increased risk of PPH; this guideline does not include specific recommendations for the management of such situations or for managing haemorrhage in women who refuse blood transfusion. Guidance on these topics is available from other sources.

Declaration of interests (guideline developers)

Ms E Mavrides MRCOG, London: None declared.

Dr S Allard, NHS Blood and Transplant and Barts Health NHS Trust, London: None declared.

Dr E Chandraharan FRCOG, London: Dr Chandraharan runs cardiotocography masterclasses for the charity Baby Lifeline.

Professor P Collins, Cardiff University: Professor Collins receives research support from CSL Behring, TEM International and Haemonetics.

Dr L Green, Consultant Haemotologist, NHS Blood and Transplant and Barts Health NHS Trust, London: None declared.

Professor BJ Hunt, King’s College London: None declared.

Mr S Riris MRCOG, London: None declared.

Dr AJ Thomson MRCOG, Paisley, Scotland: Dr Thomson has sat on advisory boards for Leo Pharma and Alliance Pharma.

Patient information leaflet

Patient information about heavy bleeding after birth (postpartum haemorrhage)