Preface

When it comes to obstetric emergencies that obstetricians fear the most, postpartum haemorrhage is always mentioned. To see hitherto fit and healthy young women fighting for their lives, during what was supposed to be one of the happiest events of their lives, is a distressing experience, not only for their families but also for health professionals involved. Whilst there has been a lot of high quality epidemiological research analysing predisposing risk factors and geographical differences, when it comes to the treatment options, postpartum haemorrhage has been largely research –free zone. One of the contributing factors is the fact that recruitment and consenting for research in these circumstances is extraordinarily difficult. Recruiting during antenatal period will cause unnecessary anxiety for thousands of women who will never experience PPH. Alternative is to recruit almost unconscious women who are hardly capable to give consent for routine interventions, let alone experimental ones.

Despite all this difficulties, the eleven chapters of this book demonstrate how much has been achieved in the last decade. Hopefully, we have managed to balance contribution of clinicians and researchers who push the boundaries of what is possible and those who continue the question effectiveness and safety of new strategies. Our aim was also to highlight the different challenges facing clinicians in low income countries. In most part of the world pregnant women and their carers are facing the challenge of access to very basic resuscitation measures including blood transfusion, whilst few of us are fortunate to ponder the effectiveness of such sophisticated and expensive measures like arterial embolisation and recombinant activated factor VII.

If, after reading this issue of BPRCOG, you challenge your team to review your local guidelines for the management of PPH our goal has been achieved. Whether they have to be changed or not is up to you.