Causes of Post-Partum Hemorrhage - Differential Diagnosis Algorithm Blood Loss: >500mL post vaginal delivery OR >1000 mL post Caesarean section Uterine Atony (70%): • Uterine fatigue (e.g. prolonged/induced labor, rapid labor, grand multiparity) • Overdistension of uterus (e.g. multiple gestation, polyhydramnios, fetal macrosomia) • Bladder distension • Uterine infection (e.g. chorioamnionitis) • Functional/anatomic distortion of uterus • Drugs — Uterine relaxants (e.g. nifedipine, magnesium sulfate, NSAlDs) Trauma (20%): • Perineal laceration (e.g. episiotomy) • Vaginal laceration / hematoma • Cervical laceration (e.g. forceps/vacuum delivery) • Uterine rupture • Uterine inversion Remnant Tissue (10%): • Retained blood clots • Retained cotyledon or succenturiate lobe • Abnormal placentation (placenta accreta, increta, or percreta) Thrombin (1%): • Thrombocytopenia • Idiopathic thrombocytopenic purpura (ITP) • Thrombotic thrombocytopenic purpura (TTP) • HELLP syndrome • Disseminated intravascular coagulation (DIC) • Anti-coagulation agents (e.g. heparin) • Pre-existing coagulopathy (e.g. von Willebrand's disease, Hemophilia A) #PostPartum #Hemorrhage #PPH #Differential #Diagnosis #Algorithm #Causes #Obstetrics #OBGyn
