Pharmacotherapeutic Management of Postpartum Hemorrhage

The incidence of postpartum hemorrhage (PPH) has increased over the past three decades and accounts for 11% of pregnancy-related deaths in the United States alone. Risk stratification and active management in the third stage of labor are key prevention strategies. An interdisciplinary approach to care of the PPH patient is necessary to prevent adverse outcomes. Uterotonic agents such as oxytocin are employed in conjunction with manipulative techniques such as uterine massage and balloon tamponade to treat atony of the uterus. Antifibrinolytic agents such as tranexamic acid have also been used. Surgical techniques, such as embolization of the pelvic artery or, ultimately, hysterectomy, are more invasive approaches. Pharmacists in the institutional setting have the opportunity to assist in risk stratification and prevention strategies, emergency management of the PPH patient, and provider and staff education, as well as clinical assessment of pharmacotherapy choice, sterile product preparation, and prevention of medication errors.