Forensic expertise in evaluation of malpractice or complications in cases of early postpartum hemorrhage

Early or primary postpartum hemorrhage (PPPH) is a significant and constant risk factor for worldwide maternal morbidity and mortality. PPPH is defined by blood loss > 500 mL after vaginal labor or 1,000 mL after cesarean section (CS) in the first 24 h, and/or as: loss of 50% of circulating blood in 3 h or acute blood loss > 1500–2000 mL. Uterine atony, placenta accreta spectrum (PAS) or morbidly adherent placenta praevia (MAPP), coagulopathy and uterine rupture are the most common causes of PPPH. Delayed medical and surgical procedures, inadequate supplementation with antifibrinolytics and blood products with the development of obstetric hemorrhagic shock (OHS) are known and proven factors of the problem of PPPH and consequent obstetric litigation [1‐5]. The goal of obstetric forensics is to assess a possible error outside the scope of good clinical practice or to determine a complication that could not be avoided despite all the procedures of modern obstetrics. …