Postpartum Hemorrhage

Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality worldwide and is the leading cause of death on the day of delivery in the United States. Bleeding is normally controlled after vaginal or cesarean delivery by myometrial contraction and the activation of local decidual hemostatic factors. Defects in either of these mechanisms along with genital tract lacerations lead to PPH. Many evidence‐based resources exist to assist in optimizing the outcome in obstetrical hemorrhage. There are two common underlying themes: checklist‐based protocols and multidisciplinary team drills. Thromboelastography and rotational thromboelastometry are point‐of‐care tests that assess coagulation in whole blood during massive transfusions that are becoming more widely used in intensive care and trauma settings. Severe maternal morbidity, or near misses, are unexpected outcomes of labor and delivery that result in significant short‐ or long‐term consequences to a woman's health.