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Special experiences and unusual circumstances

Postpartum hemorrhage has been recognized as a major cause of maternal death for as long as physicians have studied and written about childbirth. Until the 20th century, however, little was possible in the way of effective treatment, and, as is apparent in many of the chapters of this book, postpartum hemorrhage is still a frequent cause of death in many parts of the world. Even in the Western world, significant numbers of deaths and morbidity from postpartum hemorrhage continue to plague obstetricians, despite considerable advances in medical care in the last half-century. . | Section IX Special experiences and unusual circumstances 42 THE OBSTETRICIAN CONFRONTS POSTPARTUM HEMORRHAGE M. E. Setchell INTRODUCTION Postpartum hemorrhage has been recognized as a major cause of maternal death for as long as physicians have studied and written about childbirth. Until the 20th century however little was possible in the way of effective treatment and as is apparent in many of the chapters of this book postpartum hemorrhage is still a frequent cause of death in many parts of the world. Even in the Western world significant numbers of deaths and morbidity from postpartum hemorrhage continue to plague obstetricians despite considerable advances in medical care in the last half-century. During the author s career in Obstetrics which has spanned almost 40 years one of the most striking changes has been the one whereby the individual obstetrician no longer has to deal with the problem of postpartum hemorrhage alone but can call on a sophisticated team of helpers involving a whole range of other specialists. A mere glance at the contents of this book confirms that the modern management of a major postpartum hemorrhage can involve a team of anesthetists hematologists vascular surgeons gynecologists and radiologists. Clearly this change represents an advance which has saved and will continue to save countless lives not only in the developed world where such teamwork is routine but also in developing nations that are desperately looking for means to reduce maternal mortality as part of their efforts to comply with the United Nations Millennium Development Goals by the year 2015. HISTORICAL PERSPECTIVE In the middle of the 19th century maternal mortality was around 6 per 1000 live births and of those deaths about one-third were related to puerperal sepsis and the remainder were classified as accidents of childbirth which included ante- and postpartum hemorrhage and deaths from obstructed labor. Table 1 shows birth and death rates in England and Wales from .