Causes of Post-Partum Hemorrhage - Differential Diagnosis Algorithm

Blood Loss: >500mL post vaginal delivery OR >1000 mL post Caesarean section

Uterine Atony (70%):

 • Uterine fatigue (e.g. prolonged/induced labor, rapid labor, grand multiparity)

 • Overdistension of uterus (e.g. multiple gestation, polyhydramnios, fetal macrosomia)

 • Bladder distension

 • Uterine infection (e.g. chorioamnionitis)

 • Functional/anatomic distortion of uterus

 • Drugs — Uterine relaxants (e.g. nifedipine, magnesium sulfate, NSAlDs)

Trauma (20%):

 • Perineal laceration (e.g. episiotomy)

 • Vaginal laceration / hematoma

 • Cervical laceration (e.g. forceps/vacuum delivery)

 • Uterine rupture

 • Uterine inversion

Remnant Tissue (10%):

 • Retained blood clots

 • Retained cotyledon or succenturiate lobe

 • Abnormal placentation (placenta accreta, increta, or percreta)

Thrombin (1%):

 • Thrombocytopenia

 • Idiopathic thrombocytopenic purpura (ITP)

 • Thrombotic thrombocytopenic purpura (TTP)

 • HELLP syndrome

 • Disseminated intravascular coagulation (DIC)

 • Anti-coagulation agents (e.g. heparin)

 • Pre-existing coagulopathy (e.g. von Willebrand's disease, Hemophilia A)



#PostPartum #Hemorrhage #PPH #Differential #Diagnosis #Algorithm #Causes #Obstetrics #OBGyn