Genetic contribution to postpartum haemorrhage

Childbirth can be hazardous. Without modern medical interventions, one in two hundred women died in childbirth in the United Kingdom as late as the 1930s.1 These alarming rates persist today in areas where resources are scarce and births are unattended by skilled health workers.2 Not every birth can be attended by a health worker or take place in a maternity unit, even in developed countries. The best we can do is to suggest that women at particular risk for postpartum haemorrhage, the leading cause of maternal mortality worldwide,2 should be managed in settings where interventions for excessive bleeding during childbirth are available and judiciously used. There is good evidence that use of oxytocin at delivery prevents primary postpartum haemorrhage3 and that various medical and surgical interventions, including timely blood transfusion, can prevent death from postpartum haemorrhage.4

In a linked article, Oberg and colleagues (doi:10.1136/bmj.g4984) give us some valuable new insights on how to identify women who are more likely to require these interventions.5 Currently, we do not know how to reliably stratify women at risk for postpartum haemorrhage. …