Postpartum Hemorrage: Are There Physiological Mechanisms of Prevention?

Abstract

The postpartum hemorrhage (PPH) it is one of the worst complications of the pregnant woman and the leading cause of maternal mortality in the world, as it produces potentially catastrophic effects on patients, with high morbidity and morbidity. Likewise, the reduction in maternal mortality, which is particularly high in low income countries, but rising even in developed countries (as in USA), is one of the eight primary global health current goals of the WHO. In the complex pathophysiological phenomenon of PPH, the uterine contractility and connective tissue arrangement are poorly investigated. Both topics are scantly little understood and investigated, in terms of pelvic functional anatomy and pathophysiology. The anti-version uterine posture is essential for the optimal and necessary muscle contraction in the immediate postpartum stage, to avoid PPH onset. In this review, authors analyzed the physiology of uterine contraction related to the childbirth and the PPH, identifying an anatomical system involved in the physiological post-partum uterine contraction. This biological system is the integrated pelvic myofascial system and it has a prime importance in the physiological reduction of the PPH risk and to maintain uterine contractility during and after childbirth.