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
