When it comes to obstetric emergencies that obstetricians fear the most, postpartum
haemorrhage is always mentioned. To see hitherto fit and healthy young women fight-
ing 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 profes-
sionals 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 ante-
natal 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 bookdemonstrate how much
has been achieved in the last decade. Hopefully, wehavemanaged to balance contribu-
tion 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 mea-
sures like arterial embolisation and recombinant activated factor VII.
If, after reading this issue of BPRCOG, you challenge your team to review your lo-
cal guidelines for the management of PPH our goal has been achieved. Whether they
have to be changed or not is up to you.

Zarko Alfirevic*
MD FRCOG
Professor of Fetal and Maternal Medicine

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