Transfusion alone does not address the cause of the hemorrhage, and appropriate management of postpartum bleeding will most often prevent it from being needed. The placenta should be allowed to separate spontaneously in most cases, since traction risks cord rupture or uterine inversion. Uterine atony is responsible for many cases of postpartum bleeding and can often be controlled with uterine massage, intramuscular methylergonovine, or intravenous oxytocin. Adequate venous access should be assured and the patient typed and cross-matched. If the bleeding continues, emergent obstetrical consultation should be obtained because uterine curettage may be needed. Direct bimanual uterine compression or uterine packing is rarely needed. Recombinant factor VIIa has not been studied in postpartum bleeding.