Postpartum Hemorrhage (PPH) is defined as blood loss >500ml within 24 hours after delivery of the fetus, and Intractable Postpartum Hemorrhage (IPH) is defined as bleeding >1000ml that does not improve within 30-60 minutes after conventional treatment or worsens. Intractable Postpartum Hemorrhage If not treated in time, it can cause maternal death. The incidence of postpartum hemorrhage is 2%-3%, blood loss ≥500ml~1000ml is 4%-11%, blood loss >1000ml is <1%, and the incidence of intractable postpartum hemorrhage is about 1.8‰. Postpartum hemorrhage is a serious complication during childbirth and is the first cause of maternal death in China. Emergency treatment is needed when postpartum hemorrhage is >1000ml. Rapid diagnosis and treatment can save the life of the mother. Diagnostic criteria] 1. Clinical manifestations Vaginal bleeding >500ml after delivery of the fetus; the cause of postpartum hemorrhage is mainly based on medical history (mode of delivery, presence of obstetric complications and medical and surgical comorbidities), symptoms, estimation of blood loss and examination (including vaginal and general examination). Internal bleeding (e.g. broad ligament hematoma) should be ruled out when there is an unexplained increase in heart rate and decrease in blood pressure after delivery. Physical examination can help to find the cause of postpartum hemorrhage. (1) Vaginal examination can reveal whether the depth of cervical laceration reaches the vaginal fornix or whether there is a hematoma in the birth canal; (2) Examination can reveal a mass in the colorectal fossa and whether there is skin discoloration and petechiae in the perineum; (3) Abnormalities are found at the end of vaginal examination, and the soft uterine body is considered as weak contraction; if the fundus is elevated, the accumulation of blood in the uterine cavity is considered. (1) Routine blood tests: hemoglobin, platelets, leukocytes, blood type and cross-matching; (2) Coagulation routine; PT, APTT, TT, fibrinogen, ATIII, etc.; (3) Liver and kidney function, electromediastin, blood gas analysis; (4) Electrocardiogram, bedside chest X-ray. (1) uterine atony, accounting for 70%-90%, is the most common cause of postpartum hemorrhage; (2) placental factors: commonly placental impaction, placental adhesion, placental implantation or partial placental residue; (3) soft birth canal laceration (3) soft birth canal laceration (laceration): common in vaginal surgical delivery, huge baby delivery, emergency delivery, poor elasticity of soft birth canal tissue and excessive labor force; (4) coagulation defects: common in placental abruption, stillbirth, amniotic fluid embolism, severe pre-eclampsia and other obstetric complications. 5.Differential diagnosis The etiology is the main differentiation. (1) uterine rupture: history of obstructive delivery, history of intravenous oxytocin or forceps for transmaternal delivery, bleeding after the first vaginal delivery; internal bleeding is the main cause, early suspicion, early routine vaginal examination, early definite diagnosis can be made. (2) Amniotic fluid embolism: 80% occurs during or after delivery, with clinical signs of respiratory failure and cardiopulmonary circulatory disorders or allergic reactions, and the diagnosis can be confirmed if keratinized epithelium is found in peripheral blood. If it is delayed amniotic fluid embolism without expiration but with vaginal bleeding blood is not clotted, DIC (+), treat as coagulation dysfunction; [Treatment plan] Treatment principle: postpartum bleeding >1000ml according to the second and third line emergency, for the cause of bleeding, continue anti-shock and etiology treatment, correct DIC, apply antimicrobial, and protect the function of critical organs. 1.Emergency treatment On the basis of emergency treatment, call for help, while quickly establishing double venous access, actively replenish blood volume, rapidly rehydrate intravenously, crystal first and then colloid; keep airway open, mask oxygen administration; monitor bleeding volume and vital signs, dynamic monitoring of blood routine, liver and kidney function, coagulation function, cross-matching blood. Actively search for the cause and deal with it; 2. Secondary emergency treatment: (blood loss >1000ml) Anti-shock treatment: transfusion of blood and fresh frozen plasma, oxygen administration, monitoring of bleeding volume and vital signs, urine volume, oxygen saturation, dynamic monitoring of coagulation function, central venous pressure monitoring if necessary. Also treat according to the following etiology. 3.Tertiary emergency treatment (blood loss >1500ml) Indications: (1) Various refractory postpartum hemorrhages that have failed to respond to conservative treatment (such as implanted placenta, weak contractions, uterine rupture, aggressive placenta praevia, uterine cavity infection); (2) It is too late to transfer the patient or the patient’s condition is not suitable for transfer; (3) There is no condition for intra-skeletal artery embolization. Intensive care: Integrated treatment in ICU ward and multidisciplinary cooperation to protect vital organ functions. 4, emergency transport (1) the principle of local resuscitation, not transport, can be called for help. (2) postpartum hemorrhage ≥ 1000ml, still have bleeding tendency after conservative treatment, no local conditions of intra-skeletal artery embolization, in maintaining blood volume and respiratory ventilation, vital signs allow short distance transfer, have transportation, and contact with higher hospitals before transfer.