![]() The four main causes for postpartum hemorrhage are the four T’s: tone (uterine atony), trauma (lacerations, hematomas, uterine inversion or rupture), tissue (retained placental fragments), and thrombin ( disseminated intravascular coagulation). Primary postpartum hemorrhage may occur within the first 24 hours after birth, while secondary postpartum hemorrhage occurs more than 24 hours and up to 12 weeks after delivery. It is the leading cause of maternal morbidity and mortality globally (Nathan, 2019). Postpartum hemorrhage is the fifth leading cause of maternal mortality in the United States and causes approximately 11-12% of maternal deaths. Nevertheless, a blood loss greater than 500 mL in a vaginal delivery should be considered abnormal (American College of Obstetricians and Gynecologists, 2017). Postpartum hemorrhage (PPH) is defined as a cumulative blood loss greater than or equal to 1,000 mL of blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process, regardless of route of delivery.
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