Maternal Characteristics and Causes Associated with Refractory Postpartum Hemorrhage after Vaginal Birth: A Secondary Analysis of the WHO CHAMPION Trial Data

(BJOG. 2020;127:628–634) A leading cause of maternal morbidity and mortality in low- and middle-income countries is postpartum hemorrhage (PPH). The most common cause of PPH is uterine atony. As PPH occurs in 6% of all live births worldwide, the World Health Organization (WHO) recommends a set of interventions for women who begin to bleed, which include uterine massage and uterotonic medications. For women who continue to bleed despite this first-line of treatment, additional measures are recommended prior to surgical intervention including secondary uterotonics, tranexamic acid, and intrauterine balloon tamponades.