Postpartum hemorrhage or PPh is excess bleeding, than normal, after the birth of a baby. It is the main cause of maternal death. About 1 in 100 to 5 in 100 women have postpartum hemorrhage. It is most common in cesarean birth. Postpartum Hemorrhage happens more after the placenta is delivered, but it can also happen later as well. It is an obstetric emergency which needs urgent treatment to reduce the risk of mortality.
Causes of postpartum hemorrhage:
There are many causes of PPH and the causes have been described as “four T’s” i.e. tone, trauma, tissue, and thrombin. After a baby is born, the uterus generally contracts and placenta gets separated from it. After the placenta is delivered the uterus starts contracting and the outflow of blood stops. But sometimes the mother bleeds too much when the blood vessels do not close off even after the separation of the placenta from the uterus. This causes PPH.
What else may cause PPH?
- Deep tear in the cervix or tissues of the vagina or perineum
- A tear in the wall of the uterus
- Bleeding into a hidden tissue area or space in the pelvis.
- Blood clotting problems
- Rupture of uterus
Who is at risk for postpartum hemorrhage?
Most women face greater risk for postpartum hemorrhage than others. The causes for greater risks are:
- Placental abruption that is the early separation of the placenta from the uterus.
- Placenta previa. The placenta grows at the lower part of the womb.
- Overdistention of uterus and large placenta
- Multiple births
- High blood pressure problems in pregnancy
- Giving many previous births
- Delayed labor
- Rapid labor
- Usage of forceps or vacuum-assisted delivery
- Having Asian or Hispanic ethnic background
Postpartum hemorrhage symptoms:
These are the most common symptoms of postpartum hemorrhage:
- Loss of excessive blood
- Blood pressure falls
- Heart rate increases
- Red blood cells count drops
- Swelling and pain around vagina and constant flow of blood due to hematoma.
- Skin becomes pale
The symptoms of postpartum hemorrhage may look similar to other health conditions. So it’s always better to see the healthcare provider for a diagnosis to avoid complications.
How is postpartum hemorrhage diagnosed?
Diagnosis of Postpartum Hemorrhage may include many tests. So it’s better to consult the healthcare provider about the proper diagnosis and to avoid every possible risk. It may include:
- By estimating the amount of blood loss
- Measuring pulse rate and blood pressure
- Testing Red blood cell count(hematocrit)
- Blood clotting factors
Treatment of Postpartum Hemorrhage:
The main aim of treating PPh is to stop the excessive bleeding as soon as possible. The various methods are:
- Giving Medicine or massaging the uterine to activate the uterine contractions
- Removal of the remaining placental pieces from the uterus.
- Medication for activating the uterine contraction
- Examining the uterus and other pelvic tissues, vagina and others that need care for recovery.
- The usage of Bakri ballon or Foley catheter to stop the bleeding inside the uterus. This is done by packing the uterus with sponges and sterile materials.
- A surgery to open the abdomen to look for the cause of bleeding.
- A surgical removal of woman’s uterus or womb.
Postpartum hemorrhage becomes very serious if not taken into consideration very quickly. The best treatment for postpartum hemorrhage is to replace the lost blood and fluids.
Complications of postpartum hemorrhage
Due to excessive loss of blood the blood pressure may drop. This may lead to death of the mother due to shock. It also has the risk of multifetal pregnancy. There are many layers of problems that can happen due to postpartum hemorrhage:
- Your genital tract might experience lacerations
- There will be excessive blood loss
- The patient might suffer from excessive shock
- The patient might as well suffer from septicemia caused due to excessive blood loss.
- Postpartum hemorrhage also can cause death of the patient.
Apart from these, patient who has suffered from postpartum hemorrhage might as well trigger many other complications.
- Sheehan Syndrome: It is a very common problem faced by many women who has undergone tremendous blood loss during child birth. In such cases the excessive blood loss can actually hamper the pituitary gland.
- Hypovolaemic Shock: This is also known as hemorrhagic shock, which causes fatal life threats to the patients. This shock is caused when more than 20 percent of the body fluid (including blood) is lost during postpartum hemorrhage.
- Puerperal Shock: This shock is also associated with excessive blood loss along with shock. It is also known as puerperal uterine inversion and imposes severe threats to life of the patient. It normally triggers during the third stage of the pregnancy and it can cause maternal mortality.
- Maternal Mortality: Any clinical death of the mother within 42 days of the termination of pregnancy is considered as maternal mortality. This is the definition of maternal mortality, provided by World Health Organization or WHO. Postpartum hemorrhage causes maternal mortality to many women around the globe.
Prevention of Postpartum Hemorrhage:
In order to prevent PPH one should be aware of the symptoms. A good surgical management should be present. The mother should be made aware of the good prenatal diet. A good uterotonic drug is very crucial for prevention of PPH. The drug should be taken immediately upon child birth. This will help in the reduction of the overall blood loss.
When to Call the Doctor?
Postpartum hemorrhage occurs while you are giving birth to your child. However, sometimes it also happens when you are at home. If you are experiencing tremendous blood loss at home, then you should immediately seek medical help.
Some Crucial Points Regarding Postpartum Hemorrhage:
- Postpartum hemorrhage is heavy bleeding which occurs during the birth of the child.
- A drastic loss in blood can create several problems. It affects the blood pressure and it can also lead to sudden demise, in case it is not treated.
- If your uterus does not contract enough, it will lead to postpartum hemorrhage.
- A quick identification of the symptoms can stop the bleeding and can even cause full recovery.