Despite advances in medical management, postpartum hemorrhage (PPH) remains a significant cause of maternal morbidity and mortality. Primary PPH occurs in the first 24 h after delivery; secondary PPH occurs from 24 h up to 12 weeks after delivery. Severe postpartum hemorrhage is defined as blood loss greater than 1000 mL associated with clinical evidence for hypovolemia. Etiologies for both primary and secondary PPH have considerable overlap; the most common causes are uterine atony, retained placenta, infection, and coagulopathy. First-line treatments for PPH include bimanual uterine compression, examination for and treatment of cervical and vaginal lacerations, and uterotonic medications, including oxytocin, methylergonovine, and prostaglandin analogs. Early blood transfusion should be considered for sustained blood loss and signs of hypovolemic shock; screening for coagulopathy should be performed and treated when detected. Intrauterine balloon tamponade is a bedside procedure to control hemorrhage when first-line treatments fail to stop bleeding. Second-line interventions, which include uterine artery embolization and emergency hysterectomy, have high complication rates but may be lifesaving when first-line therapy is unsuccessful.