Postpartum hemorrhage (PPH), a highly challenging acute condition in obstetric clinical practice, remains one of the leading causes of maternal mortality. The scientific rigor and timeliness of its diagnosis and treatment are directly related to the bottom line of maternal and infant safety and the quality of obstetric medical services. To address this, Obstetrics and Gynecology Network specially invites Professor Huang Liping from Nanfang Hospital, Southern Medical University to share practical decision-making insights based on her clinical experience, focusing on core issues such as early warning of PPH, coordinated medical and surgical intervention, and individualized management of high-risk populations. This sharing aims to provide reference for obstetric healthcare providers, help improve the accuracy and effectiveness of treatment, and ensure maternal and infant safety.

Obstetrics and Gynecology Network:

As a life-threatening emergency after childbirth, the diagnosis and treatment level of PPH is directly related to maternal and infant safety and has always been a key focus in obstetric clinical practice. Based on your long-term clinical experience, what valuable insights and experiences can you share regarding the diagnosis and treatment of PPH?

Professor Huang Liping:

Postpartum hemorrhage has long been the leading cause of maternal death in China. However, its fatal process is rarely sudden; instead, it progresses gradually from hemorrhage and shock to disseminated intravascular coagulation (DIC) and subsequent multiple organ failure. Therefore, timely and effective intervention at the onset of bleeding is crucial to reducing maternal mortality and severe complications.

Currently, the incidence of PPH in China is estimated at 5%-10%, but this figure is mostly based on approximations and may be underestimated to a certain extent. By 2030, China aims to reduce the maternal mortality rate to below 12 per 100,000, and reducing deaths caused by PPH is a core component of achieving this goal—especially in primary care settings and remote areas. Enhancing the diagnosis and treatment capabilities for PPH is therefore of great significance, which can be carried out through the following aspects:

1. Accurate Identification of High-Risk Populations

With the liberalization of fertility policies, the proportion of cesarean sections for second and third births has increased, leading to a significant rise in the number of women with scarred uteruses—who are at high risk of PPH. In clinical practice, detailed medical history collection is essential to clarify key information such as the number of previous cesarean sections and placental implantation site, enabling proactive risk assessment and contingency planning.

2. Establishment of a Hierarchical Management Mechanism

PPH can be classified into three grades based on blood loss volume, with corresponding management strategies:

Early Warning Line (Blood loss >400ml within 2 hours after delivery): Immediately establish venous access, administer oxygen, and quickly identify the cause of bleeding. Simultaneously, initiate basic interventions such as routine oxytocin administration, uterine massage, and additional potent uterotonic agents if necessary.

Treatment Line (Blood loss 500ml-1000ml): On the basis of potent uterotonics, actively manage shock and prepare blood products. If primary care facilities lack the capacity to control bleeding, immediately request support from higher-level hospitals to avoid delays. If referral is difficult, arrange for the higher-level hospital to dispatch a team with blood products and technical expertise to assist on-site, prioritizing maternal safety.

Critical Line (Blood loss >1000ml): If medical treatment fails to control bleeding, promptly implement surgical intervention to stop hemorrhage, while strengthening vital sign monitoring and maintaining circulatory stability.

3. Strengthening Whole-Process Prevention and Early Treatment

The diagnosis and treatment of PPH should span the prenatal and intrapartum periods, adhering to the principles of "early prevention, early warning, early prediction, and early treatment." Once signs of PPH are detected, immediate and active intervention is required to avoid observational delays. Measures ranging from medication to surgery should be seamlessly coordinated to prevent disease progression.

Obstetrics and Gynecology Network:

When resuscitating patients with fatal PPH caused by placental abruption or amniotic fluid embolism, what key issues do you focus on most when using carboprost tromethamine?

Professor Huang Liping:

Both placental abruption and amniotic fluid embolism are severe obstetric emergencies that can lead to fatal PPH. When using potent uterotonics such as carboprost tromethamine, the following key aspects require special attention:

1. Assessment of Contraindications and Baseline Condition

Before administration, quickly rule out contraindications such as asthma and heart disease. Additionally, assess the underlying cause and patient status—for example, in cases of placental abruption, clarify the etiology and baseline condition to avoid exacerbating the original illness with medication.

2. Balancing Risks and Benefits of Medication

Placental abruption: If no contraindications exist, carboprost tromethamine can be added to routine uterotonics to enhance uterine contraction and control bleeding. After administration, closely monitor uterine contractions and changes in blood loss volume.

Amniotic fluid embolism: This condition has an acute onset and is often complicated by cardiac insufficiency and coagulation disorders. Before medication, carefully evaluate its necessity. In addition to contraindications, vigilantly monitor for potential side effects such as vasospasm and increased cardiac load. During administration, real-time monitoring of blood oxygen saturation, blood pressure, and hemodynamic parameters is essential, with careful differentiation between drug side effects and disease manifestations.

3. Emphasizing Comprehensive Treatment and Disease Monitoring

Carboprost tromethamine is only one component of comprehensive resuscitation. If the patient's condition continues to deteriorate despite medication, promptly switch to surgical intervention. Throughout the resuscitation process, prioritizing the maintenance of vital signs and circulatory stability, combined with multidisciplinary collaboration, is critical to improving the success rate of treatment.

Finally, it is crucial to emphasize that for high-risk populations of PPH, early identification, early medication, early treatment, and early referral must be implemented to maximize maternal and infant safety.

Summary

Postpartum hemorrhage is the leading cause of maternal death. The increasing number of high-risk pregnant women has rendered single-modal treatment insufficient. Experts point out that promoting PPH management in primary care settings faces challenges such as inadequate hardware, limited staff skills, and insufficient blood supply, highlighting the need to strengthen high-risk identification and other measures. Medications for PPH are categorized into preventive and therapeutic types, with adjustments required for special populations. Additionally, the principles of hemostasis in scarred uteruses, difficulties in early identification of bleeding, and medication and coagulation management in amniotic fluid embolism are discussed, providing valuable references for obstetric healthcare providers.

Expert Profile

Professor Huang Liping

Nanfang Hospital, Southern Medical University

Chief Physician, Professor, Doctoral Supervisor, Postdoctoral Cooperation Supervisor, Director of Obstetrics and Gynecology Department, Nanfang Hospital, Southern Medical University

❖ Youth Committee Member, 9th Perinatal Medicine Branch, Chinese Medical Association

❖ Youth Committee Member, 3rd Obstetrics and Gynecology Physicians Branch, Chinese Medical Doctor Association

❖ Standing Committee Member, 2nd Perinatal Nutrition and Metabolism Professional Committee, Chinese Maternal and Child Health Association

❖ Vice Chairperson, Obstetrics and Gynecology Branch, Guangdong Hospital Association

❖ Standing Committee Member, 8th Perinatal Medicine Branch, Guangdong Medical Association

❖ Vice Chairperson of Youth Committee, 13th Obstetrics and Gynecology Branch, Guangdong Medical Association

❖ Standing Committee Member, Maternal-Fetal Medicine Professional Committee, Guangdong Health Management Committee

❖ Standing Committee Member, 2nd Obstetrics and Natural Childbirth Promotion Professional Committee, Guangdong Maternal and Child Health Association

❖ Standing Committee Member, Microecology Medicine Branch, Guangdong Precision Medicine Application Association

❖ Recipient of honors including "Young Post Expert" of Guangdong Health System, "Outstanding Young and Middle-Aged Doctor" of Guangdong's Strongest Departments, and the 5th "Yangcheng Good Doctor". She has presided over 3 National Natural Science Foundation projects and published papers as first author or corresponding author in international renowned journals such as Gut, Advanced Science, and JEV in the past 5 years.

❖ Discovered that gut microbiota dysbiosis is a potential key etiology of preeclampsia, with the research results published as a cover article in Gut and featured in a special commentary in JAMA.

Editor-in-Charge: Lily