Zhang et al listed criteria for the diagnosis of severe postpartum hemorrhage. The authors are from Universite Libre de Bruxelles, University of Oxford and members of the EUPHRATES Group.


Criteria for severe postpartum hemorrhage - one or more of the following:

(1) need for 1 or more red blood cell transfusions

(2) intravenous fluid expansion to maintain blood pressure

(3) arterial embolisation of the uterus

(4) performance of a surgical procedure

(5) admission to the intensive care unit (ICU)

(6) treatment with recombinant Factor VII

(7) death from hemorrhage


A problem following vaginal deliveries is the accurate measurement of blood loss. Measurement is often inaccurate and can underestimate the severity of the problem. The authors recommend use of a collector bag to accurately collect and measure blood loss.



• Clinicians vary in the threshold that they use for a blood transfusion.

• A woman with antepartum anemia may require transfusion after mild to moderate blood loss.

• Some of the interventions are not available in resource-poor settings.


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