Postpartum hemorrhage (PPH) is an obstetric emergency with many potentially effective interventions for management (table 1). In patients with PPH who have had a vaginal birth or whose cesarean delivery has been completed, medical and minimally invasive approaches are the preferred treatment approaches; laparotomy is generally a last resort that is performed when less invasive interventions have failed. During cesarean delivery, uterotonic drugs and manual uterine massage and compression are still the initial treatments for bleeding due to atony, but uterine compression sutures and other operative interventions for control of hemorrhage are performed sooner since the abdomen is already open. This topic will discuss treatment approaches to PPH that require laparotomy. Medical and minimally invasive management of patients with PPH is reviewed separately (see "Postpartum hemorrhage: Medical and minimally invasive management"). An overview of issues related to PPH: incidence, pathogenesis, risk factors, clinical presentation and diagnosis, general principles of planning and management, morbidity and mortality, and recurrence, is also available separately.