evention and Management of

Postpartum Fiaemorrhage
These guidelines have been reviewed and approved by the
Clinical Practice Obstetrics Committee

PRINCIPAL AUTHORS
N an S ch u urm ans , M D, FR C SC , E dmo nton, A B ,
Catherin e MacKinnon MD, FRCSC, Brantford, ON
Carolyn Lane MD, CCFP, Calgary, AB
Duncan Etches MD, CCFR Vancouver, BC

CAL PRACTICE OBSTETRICS COMMITTEE MEMBERS

C ath er i n e M ac K i nnon (C hai r), M D, F R CS C, Bran tfo rd, O N
Marc-Yvon Arsenault, MD, FRCSC, LaSalle, QC
Yvonne Cargill, MD, FRCSC, Ottawa, ON
Iren e Coll iton, MD, C CFP, E dmonton, AB
Guy-Paul Gagne, MD, FRCSC, LaSalle, QC
Franklin Kum, MD, FRCSC, St. Johns, NF
Carolyn Lane, MD, CCFP, Calgary, AB
Marie-Jocelyne Martel, MD, FRCSC, Saskatoon, SK
Ann Sprague, RN, Ottawa, ON

DEVELOPMENT Objective: the primary objective of these guidelines is to

al aspects of Postpartum Haemorrhage (PPH)
elines to help clinicians prevent and manage In preparation of this paper, Medline references were sought
ng postpa tum. r
using the MeSH heading postpartum haemorrhage (PPH).
on, appropriate intervention, keys to minimiz- All English articles published before September 1999 were
obtained and the abstracts of articles in other languages were Outcomes: establish practice
be at particularly high risk of PPH and toreviewed. References in the articles were also scrutinized for
ervention should excessive bleeding occur further useful documents which were also obtained. The
the Qualify of Evidence of he Canadian task askT
Cochrane Library was searched for re evant studies. The l

odic Health Examination. ALARM Course Manual was consulted.

d by experts In the field of obstetrics. The quality of the evidence for each of the recommenda?Benefits, harms and costs: th
agement techniques have been evaluated tions is indicated by a Roman numeral In brackets following the
onvenience, accuracy, availability and safety recommendation. The grading system used is that of the Cana-
ns: the 12 recommendations listed in the dram lack force on the Periodic I health Exam.' Them, guidelines
been graded according to the level of evi-were developed by the Clinical Practice Obstetrics Committee
hey are based of the Society of Obstetricians and Gynaecologists of Canada. Validation: Medline reference
um haemorrhage. The Cochrane Library was
vant studies.The ALARM course Manual WAS INTRODUCTION consulted.
ped and reviewed by the Clinical Practice In spite of marked improvements in management, early PPH
mittee and approved by the Council of the remains a significant contributor to maternal morbidity and
mortality both in developing (,cuntries and in hospitals 2,3

r g i n g clinical and [11, , forl t U, should not ix . )ri,ti u~

1 1 "d

c o u p e A treatment o f 1 1 cduf 0 M o w o l i l mo l l , I hey

q , ,
t l e local level. N o n t of i ~ ~_O it( f I ; J J u ;1- 1 V% 1 ;1,2[ ! of S : " ) G ( " .
1