Within 24 hours after delivery, bleeding of 500 ml or more is called postpartum hemorrhage. The incidence of postpartum hemorrhage is about 10% to 20%. According to Nanjing survey, the rate of bleeding in vaginal delivery is 23%, and nearly 50% in cesarean delivery. It means that usually we underestimate the amount of blood loss in clinical practice. Severity of postpartum hemorrhage: postpartum hemorrhage may lead to serious complications if it is not diagnosed and properly treated in time. Such as hemorrhagic shock, dilutional coagulation abnormalities, acute renal impairment, multi-organ functional impairment and even death. The pituitary gland may be affected, with delayed or no lactation and Silhan’s syndrome. The high mortality rate makes postpartum hemorrhage the leading cause of maternal death worldwide, with 25% of the global maternal mortality rate of 430/100,000 being due to postpartum hemorrhage. Risk factors for postpartum hemorrhage: Prenatal: preeclampsia, primiparity, multiple births, history of previous postpartum hemorrhage, history of cesarean section, antepartum hemorrhage, and giant babies. Intrapartum: prolonged third stage of labor, lateral episiotomy, obstructed descent, tearing of the birth canal, median episiotomy, assisted labor, prolonged labor. Prevention of postpartum hemorrhage: The following measures can reduce the prevalence of postpartum hemorrhage: 1. Check prenatal hemoglobin and correct anemia before delivery. Do perinatal health care and control fetal weight. 2. Consider performing a lateral episiotomy only if the fetal heart rate is not normal or if the perineum is too tight and affects the delivery. 3.The third stage of labor should be handled actively instead of expectantly. 4. After completing the delivery record, recheck the woman’s vital signs and vaginal bleeding with the aim of detecting chronic, persistent bleeding that may be overlooked after the third stage of labor. Expectant management includes waiting for signs of placental separation or allowing the placenta to deliver on its own, or for nipple stimulation. Proactive management of the third stage of labor includes administration of oxytocin at the prelabor shoulder, prompt clamping to cut the umbilical cord, and appropriate traction. This method can reduce bleeding by 2/3. These measures will reduce the amount of postpartum bleeding but will not eliminate it. It needs to be prevented for every delivery. Common methods of dealing with postpartum hemorrhage The general resuscitation needs to be done quickly in case of massive blood loss, including: asking for help; keeping the airway open to maintain respiration and circulation; establishing intravenous access with double tubes (9 gauge indwelling needle) and giving saline or balanced fluids; administering oxygen by mask; contacting laboratory tests (blood type, cross-matching, routine blood tests, coagulation tests); and considering blood transfusion. Consider potential hematoma, uterine rupture, uterine involution, allergy, amniotic fluid embolism, or pulmonary embolism if blood pressure drops without significant blood loss. If there is significant active bleeding before delivery of the placenta, oxytocin should be given along with appropriate traction on the umbilical cord. This method, if unsuccessful, requires hand detachment of the placenta. If a clear boundary cannot be found between the placenta and the uterus, it may be due to placental implantation. This often requires curettage or surgical intervention. If the placenta is not delivered intact, the residual portion needs to be treated by hand extraction or curettage. After delivery of the placenta, the cause of active bleeding is weak contractions. Therefore, the bleeding can be reduced first by massaging the uterus, followed by intramuscular or intravenous administration of oxytocin. The vagina and perineum should be checked for tears and repaired if necessary. If the tone of the uterus improves after massage and oxytocin, but becomes soft after rebleeding, it is likely that the contractions are weak. Another contraction agent, ergometrine or prostaglandin neomampeh, can be given to relieve the bleeding. If the bleeding persists, call for back-up personnel for possible surgical intervention. Neostigmine may be repeated. At this point, consider establishing an additional intravenous line and performing immediate laboratory tests. The decision to give blood products will be based on the results of the tests. Plasma should be given whenever 5 to 10 units of red blood cells are transfused. Uterine tamponade may be considered and, if necessary, surgery is performed to diagnose and treat unresponsive weak contractions, placenta implantation, uterine involution, uterine rupture, or hematoma.