	Defined as excessive blood loss that occurs within 24 hours of delivery (primary PPH) or >24 hours and up to 12 weeks postpartum (secondary PPH). Top 3 causes of maternal morbidity..
History	Minor PPH = 500-1000ml without shock Major PPH = >1000ml with shock 2o bleed may be due to endometritis
Immediate management	Impending bleeding doom Escalate early (to whichever specialty should be stopping the bleed) Right place - resus, and on to theatre? IR? Vasc access and bloods: 2x large bore cannula Crossmatch, FBC, coag screen, VBG, LFT Haemostatic rescuscitation: TXA (not for UGIB/peptic ulcer disease) Correct coagulopathy Anticoagulant reversal Optimise clotting: keep warm, aim iCa >1.1 (10ml 10% Ca gluconate PRN) See Massive haemorrhage
Underlying causes	Tone (Uterine atony): - Uterine massage - Oxytocin IV (vaginal delivery - 5 IU; LSCS - 1U + infusion) - 2nd line: Ergometrine/carboprost/misoprost (can be given SL/PR) → caution with prostaglandins in asthma Trauma/tears: repair 'em Tissue (retained products): - Manual extraction - D&C is 2nd line Thrombin (coagulopathy): Devascularisation, uterine artery embolisation, repair of uterine rupture

risk factors for uterine atony

Prolonged labour
Precipitate labour
Dysfunctional labour
Uterine overdistension:
- Multiple pregnancy
- Polyhydramnios
- Macrosomia (baby large for gestational age).
Grand Multiparity
Uterine abnormalities: fibroids
Intrauterine infection

WOMAN trial 2017