Highlights
- •Hemorrhage is the leading contributor to maternal mortality worldwide.
- •High and low resource settings have different problems and solutions to hemorrhage.
- •Maternal mortality is decreasing in low resource settings as hospital births increase.
- •Maternal mortality is now increasing in some high resource settings.
Abstract
The possibility of hemorrhage will always co-exist with pregnancy, whether anticipated
or not. It remains the unwelcome guest in the corner of every delivery room, stealing
the lives of young women every day across the globe. In 2014, the World Health Organization
reported that hemorrhage was the leading contributor to maternal mortality worldwide,
with nearly 75% of maternal deaths due to postpartum hemorrhage. In low resource settings,
while maternal mortality is decreasing, hemorrhage remains the single most important
contributor to maternal death. Hospital-based deliveries with skilled birth attendants
have been encouraged to improve outcomes and, as a result, hospital births have dramatically
increased. However, access to higher levels of emergency obstetric care as well as
blood products and therapeutic resources remain limiting factors. Meanwhile, in high
resource settings, maternal mortality from hemorrhage is increasing, particularly
among women of color. While very rare, mortality from hemorrhage generally follows
medical interventions such as surgical management of placenta accreta or emergency
cesarean section. Primary prevention therefore requires careful selection and conduct
of medical interventions, as well as the provision of high quality, supportive, and
safe maternity care. It is clear that there is not one single solution in preventing obstetric hemorrhage
on a global scale. The international community must employ creative solutions to reduce
this ever-present problem.
Keywords
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Published online: March 24, 2021
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