Die postpartale Hämorrhagie tritt bei etwa 4% aller Entbindungen in industrialisierten
Ländern auf und zeigt eine steigende Inzidenz. Die schwerwiegenden Auswirkungen auf
das maternale Outcome erfordern eine rasche Diagnosestellung und Ursachenidentifizierung
mit nachfolgendem zielgerichtetem sowie interdisziplinärem Management der Blutstillung,
Kreislaufstabilisierung und Gerinnungstherapie.
Abstract
Postpartum hemorrhage (PPH) affects about 4% of all deliveries in high-income countries
and continues to rise, a trend attributable to the increase in caesarean section rates
and maternal morbidity. Preventive measures such as the precautionary administration
of uterotonics effectively reduce the risk of severe bleeding irrespective of birth
mode. As a time-critical condition and a significant contributor to adverse maternal
outcomes, PPH needs to be diagnosed early by measuring, not estimating, blood losses.
Institutional treatment algorithms should be available to guide stage-based interdisciplinary
management without delay. The main therapy goals are to identify the etiology and
stop the bleeding by using uterotonics and mechanical and surgical interventions,
to restore hemodynamic stability by volume and transfusion therapy and to optimize
hemostasis by laboratory- and viscoelastic assay-guided factor replacement. This review
highlights current recommendations for
prevention, diagnosis and treatment of PPH.
Schlüsselwörter
postpartale Blutung - vaginale Geburt - Kaiserschnitt - Uterusatonie - Koagulopathie
Keywords
postpartum haemorrhage - vaginal birth - cesarean section - uterine atony - coagulopathy
