Postpartum hemorrhage (PPH) is a highly challenging acute emergency in clinical obstetrics. It is not only one of the leading causes of maternal death, but its diagnosis and treatment decisions are also directly related to maternal and infant safety and the quality of obstetric care. With the rising proportion of high-risk pregnant and postpartum women—such as preeclampsia complicated with diabetes and obesity, and the increasing incidence of complex cases including pernicious placenta previa and repeat cesarean section—a single therapeutic approach can hardly address diverse bleeding scenarios. For this reason, the Obstetrics and Gynecology Network specially invited Professor Zhou Shu from the West China Second University Hospital, Sichuan University, to conduct an in-depth discussion on core issues including preventive strategies for postpartum hemorrhage, the synergistic application of medication and interventional therapy, and individualized intervention for high-risk groups. She shared clinical decision-making thinking in practical practice, providing obstetric medical staff with a reference that integrates theoretical guidance and practical value, and helping to improve the accuracy and effectiveness of postpartum hemorrhage treatment.
Obstetrics and Gynecology Network: The growing number of advanced-age and high-risk pregnant and postpartum women has brought new pressure to the prevention and treatment of postpartum hemorrhage. For parturients with high-risk factors for postpartum hemorrhage, such as placenta previa and multiple pregnancy, what targeted preventive measures should be taken during the prenatal period?
Professor Zhou Shu
Advanced maternal age not only increases the risk of postpartum hemorrhage, but may also trigger complications such as preeclampsia and placenta previa. In particular, parturients with a history of cesarean section have a higher incidence of placenta previa. Therefore, the prevention of postpartum hemorrhage requires a three-level implementation strategy:
✅ Primary prevention: Reduce risks through lifestyle adjustments, such as weight management and nutritional supplementation.✅ Secondary prevention: Establish preventive awareness in advance and make adequate response preparations before delivery to avoid passive hemostasis after bleeding occurs.✅ Tertiary prevention: Immediately administer medication or take intervention measures once bleeding occurs to minimize blood loss.
Specific preventive measures can be carried out in the following aspects:
1. Weight management is the core
Weight is closely associated with the risk of postpartum hemorrhage: underweight pregnant women have low resistance, a high risk of anemia, and great difficulty in blood volume management; obese pregnant women are prone to preeclampsia, with a significantly increased probability of postpartum hemorrhage. Therefore, it is imperative to strictly follow the national guidelines for maternal health care:
Clinical data show that most patients with preeclampsia are overweight, so weight management is the top priority for reducing high-risk factors.
2. Early intervention for anemia and optimal blood volume reserve
Postpartum hemorrhage is primarily characterized by the loss of red blood cells and coagulation factors, and anemia exacerbates the risks following bleeding. At present, there are still undernourished (formerly malnourished) pregnant women. Such pregnant women need not only weight management but also focused correction of anemia: screen the causes of anemia before and during pregnancy, and improve hemoglobin levels through nutritional intervention; ensure sufficient red blood cell reserve in pregnant women before delivery to cope with potential bleeding.
3. Prenatal high-risk assessment and contingency plan preparation
For pregnant women with high-risk factors such as placenta previa and multiple pregnancy, prenatal risk assessment should be completed and intervention measures prepared in advance:
Obstetrics and Gynecology Network: In practical clinical application, Hemabate is often used in combination with Bakri Balloon, uterine compression suturing and other techniques in cases of repeat cesarean section or pernicious placenta previa for the prevention and control of postpartum hemorrhage. What are the specific synergistic mechanisms of this combined therapy? How to achieve more efficient hemostatic effects through complementary actions under different pathophysiological conditions?
Professor Zhou Shu
The hemostatic mechanisms for postpartum hemorrhage fall into two categories: one is vascular compression through uterine contraction (physiological hemostasis), and the other is rupture vessel occlusion via thrombus formation (protective mechanism under hypercoagulable state). For severe bleeding caused by pernicious placenta previa, placental abruption and other conditions, a single therapeutic approach often has limited efficacy, and a combined "medical drug + surgical mechanical" regimen is required.
1. Synergistic mechanism: Complementary principle of medication and mechanical measures
✅ Effect of Hemabate and other drugs: Actively compress blood vessels and reduce wound bleeding by stimulating the contraction of uterine smooth muscle (via uterine myometrial contraction receptors and prostaglandin receptors). Its core is to enhance the uterus’s active contractility, serving as the foundation of medical treatment.✅ Effect of Bakri Balloon: Directly block bleeding points through mechanical compression of the uterine cavity wound, belonging to passive compression. It is suitable for scenarios with extensive uterine cavity wounds (e.g., wounds after placental accreta dissection).✅ Effect of uterine compression suturing: Achieve hemostasis by folding and suturing the uterine myometrium to appose wound surfaces, with dual effects of mechanical compression and enhanced uterine contraction.
In combination, drugs strengthen active uterine contraction, and mechanical measures compensate for local contraction insufficiency through physical compression, forming a dual hemostatic network of active contraction plus passive compression, which is particularly effective for refractory bleeding.
2. Complementary application under different physiological states
3. Principles of clinical application
The core of combined therapy is rapid availability and synergistic efficacy:
In summary, the combination of medical drugs and surgical mechanical measures is a double insurance for addressing complex postpartum hemorrhage. Their synergistic effect can minimize bleeding risks and safeguard maternal and infant safety.
Expert Profile
Zhou Shu, Professor
West China Second University Hospital, Sichuan UniversityDoctor of Obstetrics and Gynecology, Chief Physician, Master’s SupervisorSpecialty: Perinatal Medicine
Academic Titles & Positions:Academic and Technical Leader of Sichuan Provincial Health CommissionMember of the Delivery Room Safety and Midwifery Group, Perinatal Medicine Branch of Chinese Medical AssociationDeputy Director and Secretary-General of the Women’s Health Branch, Sichuan Preventive Medicine AssociationVice Chairperson of the Obstetrics and Gynecology Branch & Chairperson of the Obstetrics Group, Sichuan Rehabilitation Medicine AssociationChairperson of the Perinatal Medicine Branch, Chengdu Medical AssociationChairperson of the Natural Childbirth Promotion Professional Committee, Chengdu Maternal and Child Health AssociationMember of the Cord Blood Collection Management Group, Cord Blood Application Committee, China Maternal and Child Health AssociationExpert of the Sichuan Provincial Obstetrics and Gynecology Medical Quality Control CenterMedical Appraisal Expert of Chengdu Medical Association
Academic & Professional Experience
Graduated from West China University of Medical Sciences in 1997, and obtained Master’s and Doctoral degrees in Perinatal Medicine from Sichuan University. She studied at the International Center for Reproductive Health, Ghent University in Belgium for one year in 2015.
Since graduating and staying at the university in 1997, she has been engaged in clinical, teaching and scientific research work in obstetrics and gynecology for more than 20 years, with rich experience in perinatal health care and the management of high-risk pregnancy.
She has led and participated in more than 10 national natural science foundation projects and provincial and ministerial scientific research projects, published more than 40 papers in domestic and foreign professional journals, and compiled 5 monographs.
Main Research Directions
Perinatal infection and immunity, including the correlation between adverse pregnancy outcomes (e.g., miscarriage, preterm birth) and maternal-fetal interface immune response, trophoblast autophagy and immune response, and the prevention and treatment of pregnancy-related inflammatory diseases.
Editor-in-Charge: Lily
