Diagnosis and management of postpartum hemorrhage. ACOG technical bulletin number 143 --July 1990.

Early postpartum hemorrhage remains a significant cause of maternal morbidity and mortality. The most common cause is uterine atony, and initial therapy is conservative in these patients. Conservative therapy may consist of uterine massage or manual compression, blood and fluid replacement, and medical therapy with a uterotonic agent. Surgical therapy may include vessel ligations, in order to preserve childbearing capacity, or hysterectomy. Hysterectomy can be life-saving for patients who are refractory to conservative therapy and may be the primary treatment for patients with placenta accreta or uterine rupture. Patients with significant bleeding should be transfused with whole blood or its components.