Strategies to manage postpartum haemorrhage

Abstract

Postpartum haemorrhage (PPH) is a global problem and the solutions to reducing it are complex. This thesis uses a mixture of research methods to investigate strategies that might improve the burden of blood loss following childbirth. The main findings are: 1. The use of contraception medication prior to pregnancy warrants further research as progesterone only contraception in particular might be associated with an increase in the risk of subsequent PPH; 2. The use of antidepressant medication during late pregnancy does not appear to increase the risk of PPH; 3. Following childbirth, a preventative uterotonic drug may not need to be given immediately; a delay of up to 5 minutes does not appear to increase the risk of bleeding; 4. There is little evidence to recommend the use of oxytocin, carbetocin, or misoprostol over each other for use as a first line drug to treat PPH; 5. Less than half of patients who had a PPH of 500mL received treatment uterotonic medication; 6. There is no appreciable long-term effect of PPH on mental health, but there is an increased risk of developing postnatal depression and post traumatic stress disorder; 7. There is no appreciable effect of PPH on cardiovascular health

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