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At a meeting in <jats:styled-content style=\"fixed-case\">N<\/jats:styled-content>ovember 2011, the panel agreed on a definition of severe <jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content> that would identify those women who were at a high risk of adverse clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The panel agreed on the following definition for severe persistent (ongoing) <jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content>: <jats:italic>\u201cActive bleeding &gt;1000\u2009<jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content> within the 24 hours following birth that continues despite the use of initial measures including first\u2010line uterotonic agents and uterine massage.\u201d<\/jats:italic> A treatment algorithm for severe persistent <jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content> was subsequently developed. Initial evaluations include measurement of blood loss and clinical assessments of <jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content> severity. Coagulation screens should be performed as soon as persistent (ongoing) <jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content> is diagnosed, to guide subsequent therapy. If initial measures fail to stop bleeding and uterine atony persists, second\u2010 and third\u2010line (if required) interventions should be instated. These include mechanical or surgical maneuvers, i.e., intrauterine balloon tamponade or hemostatic brace sutures with hysterectomy as the final surgical option for uncontrollable PPH. Pharmacologic options include hemostatic agents (tranexamic acid), with timely transfusion of blood and plasma products playing an important role in persistent and severe <jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Early, aggressive, and coordinated intervention by health care professionals is critical in minimizing blood loss to ensure optimal clinical outcomes in management of women with severe, persistent PPH.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.12550","type":"journal-article","created":{"date-parts":[[2014,3,12]],"date-time":"2014-03-12T08:00:40Z","timestamp":1394611240000},"page":"1756-1768","source":"Crossref","is-referenced-by-count":177,"title":["Evaluation and management of postpartum hemorrhage: consensus from an international expert panel"],"prefix":"10.1111","volume":"54","author":[{"given":"Rezan","family":"Abdul\u2010Kadir","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Royal Free Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"McLintock","sequence":"additional","affiliation":[{"name":"National Women's Health Auckland City Hospital  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne\u2010Sophie","family":"Ducloy","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia Centre Hospitalier R\u00e9gional Universitaire de Lille  Lille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazem","family":"El\u2010Refaey","sequence":"additional","affiliation":[{"name":"Chelsea &amp; Westminster Hospital and Imperial College School of Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"England","sequence":"additional","affiliation":[{"name":"Department of Anaesthetics Royal Free Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Augusto B.","family":"Federici","sequence":"additional","affiliation":[{"name":"Department of Clinical and Community Sciences L. 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