Peripartum Haemorrhage: Haemostatic Aspects of the Updated Peripartum Haemorrhage Guideline of the German-Speaking Countries

Research output: Contribution to journalReview articleContributedpeer-review


  • Heiko Lier - , University of Cologne (Author)
  • Thorsten Annecke - , Witten/Herdecke University (Author)
  • Thierry Girard - , University Hospital Basel (Author)
  • Georg Pfanner - , Department of Anesthesiology and Intensive Care Medicine (Author)
  • Wolfgang Korte - , Center for Laboratory Medicine and Haemostasis and Haemophilia Center (Author)
  • Oliver Tiebel - , Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus Dresden (Author)
  • Dietmar Schlembach - , Clinic of Obstetric Medicine (Author)
  • Christian von Heymann - , Department of Cardiac Anaesthesia (Author)


BACKGROUND: Peripartum haemorrhage (PPH) is a potentially life-threatening complication. Although still rare, the incidence of peripartal haemorrhage is rising in industrialised countries and refractory bleeding remains among the leading causes of death in the peripartal period.

SUMMARY: The interdisciplinary German, Austrian, and Swiss guideline on "Peripartum Haemorrhage: Diagnostics and Therapies" has reviewed the evidence for the diagnostics and medical, angiographic, haemostatic, and surgical treatment and published an update in September 2022 . This article reviews the updated recommendations regarding the early diagnosis and haemostatic treatment of PPH. Keystones of the guideline recommendations are the early diagnosis of the bleeding by measuring blood loss using calibrated collector bags, the development of a multidisciplinary treatment algorithm adapted to the severity of bleeding, and the given infrastructural conditions of each obstetric unit, the early and escalating use of uterotonics, the therapeutic, instead of preventative, use of tranexamic acid, the early diagnostics of progressive deficiencies of coagulation factors or platelets to facilitate a tailored and guided haemostatic treatment with coagulation factors, platelets as well as packed red blood cells and fresh frozen plasma when a massive transfusion is required.

KEY MESSAGES: Essential for the effective and safe treatment of PPH is the timely diagnosis. The diagnosis of PPH requires the measurement rather than estimation of blood loss. Successful treatment of PPH consists of a multidisciplinary approach involving surgical and haemostatic treatments to stop the bleeding. Haemostatic treatment of PPH starts early after diagnosis and combines tranexamic acid, an initially ratio-driven transfusion with RBC:plasma:PC = 4:4:1 (when using pooled or apheresis PC) and finally a goal-directed substitution with coagulation factor concentrates for proven deficiencies. Early monitoring of coagulation either by standard parameters or viscoelastic methods facilitates goal-directed haemostatic treatment.


Original languageEnglish
Pages (from-to)547-558
Number of pages12
JournalTransfusion Medicine and Hemotherapy
Issue number6
Publication statusPublished - Dec 2023

External IDs

PubMedCentral PMC10712975
Scopus 85180436963