Author(s)

Rachael Bailey¹, Michael R. Foley¹, Nicole Hall², Adiel Fleischer³, Mary D’Alton⁴, Gary A. Dildy², Michael A. Belfort², Gary D. Hankins⁵, Steven L. Clark²

¹University of Arizona College of Medicine Phoenix, Banner University Medical Center Phoenix, Phoenix, USA.
²Baylor College of Medicine/Texas Children’s Hospital, Houston, USA.
³Northwell Health-Hofstra School of Medicine, New York, USA.
⁴Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, USA.
⁵University of Texas Medical Branch at Galveston, Galveston, USA.

Uterine atony remains the major cause of postpartum hemorrhage, and of death from postpartum hemorrhage in the United States. While existing guidelines outlining a general approach to postpartum hemorrhage are useful, recent data suggest that greater specificity may be necessary to significantly impact mortality. We present a highly specific and methodical approach to the management of uterine atony, which addresses what we believe to be the most common cause of preventable maternal hemorrhagic death in the US—lack of an intensive, focused approach to atony and perseverance with therapies that are not working. This protocol should result in cessation of hemorrhage by medical or surgical means within 1 hour of diagnosis. We then apply this protocol to a number of illustrative cases of maternal death due to atony. An approach involving the active management of uterine atony may assist clinicians in avoiding severe morbidity and mortality from uterine atony.

Postpartum Hemorrhage, Obstetric Hemorrhage, Uterine Atony

Bailey, R. , Foley, M. , Hall, N. , Fleischer, A. , D’Alton, M. , Dildy, G. , Belfort, M. , Hankins, G. and Clark, S. (2016) The Active Management of Postpartum Uterine Atony—A Checklist Based Approach. Open Journal of Obstetrics and Gynecology, 6, 646-653. doi: 10.4236/ojog.2016.611081.