Recognition and management of persistent postpartum haemorrhage: Time to take timing seriously

Abstract

Persistent postpartum haemorrhage is a major cause of maternal mortality and severe morbidity after childbirth. Part I of this thesis discusses uncertainties in management of women with postpartum haemorrhage and opportunities to improve maternal outcome. Part II is a description of women with the highest risk of adverse haemorrhage-related outcomes: women with concurrent preeclampsia and women in whom the bleeding is refractory to first-line interventions to stop the haemorrhage. Part III of the thesis compares the outcomes after different strategies for fluid resuscitation and after different strategies for timing of plasma transfusion in these women. In part III we also discuss methodological challenges encountered in studies among women with severe postpartum haemorrhage, methods to deal with this time-dependent confounding.