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Postpartum Hemorrhage

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  3. Postpartum Hemorrhage

Overview of Postpartum Hemorrhage

Postpartum hemorrhage (PPH) is excessive bleeding from the birth canal after childbirth. It is a severe and potentially life-threatening condition that can occur in both vaginal and cesarean deliveries.

Prevalence of Postpartum Hemorrhage

Postpartum hemorrhage is the leading cause of maternal mortality worldwide. According to the World Health Organization (WHO), almost 14 million women suffer postpartum hemorrhage, with an estimated 70,000 deaths globally. 

Signs and Symptoms of Postpartum Hemorrhage

The symptoms of postpartum hemorrhage (PPH) can vary depending on the severity of the bleeding. Mild PPH may not have noticeable symptoms, while severe PPH can be life-threatening and require immediate medical attention. Some common symptoms of PPH include:

  • Excessive bleeding: This is the hallmark symptom of postpartum hemorrhage. Excessive bleeding can occur immediately after delivery or up to 12 weeks postpartum.
  • Rapid or weak pulse: Due to blood loss, the heart rate may increase or become weaker than usual.
  • Low blood pressure: Due to the loss of blood, the blood pressure may drop, leading to dizziness or fainting.
  • Fatigue or weakness: Due to the loss of blood, the woman may feel tired or weak.
  • Pale skin or mucous membranes: Due to the loss of blood, the skin or mucous membranes may appear pale or bluish.
  • Abdominal pain or discomfort: This can occur if there is retained placental tissue or other complications causing bleeding.
  • Clots or tissue passing through the vagina: It can be a sign of retained placental tissue or other complications.

Women need to be aware of the signs and symptoms of postpartum hemorrhage and seek medical attention immediately if they suspect they are experiencing excessive bleeding after delivery.

Types of Postpartum Hemorrhage

There are two types of postpartum hemorrhage (PPH):

  1. Primary Postpartum hemorrhage: When excessive bleeding occurs within 24 hours after childbirth. Primary PPH is usually caused by poor uterine contractions (uterine atony) or trauma to the birth canal.
  2. Secondary Postpartum hemorrhage: It occurs more than 24 hours but less than 12 weeks after delivery. Secondary PPH is usually caused by retained placental tissue, uterine infection, or abnormal blood clotting.

It's important to note that PPH can also be classified based on the severity of bleeding. Mild PPH involves a blood loss of 500-1000 ml, moderate PPH involves a blood loss of 1000-2000 ml, and severe PPH involves a blood loss of more than 2000 ml. However, the classification of PPH based on severity may vary among different healthcare settings.

Causes of Postpartum Hemorrhage

Postpartum hemorrhage (PPH) can have several causes, including:

  • Uterine atony: This is the most common cause of PPH and occurs when the uterus fails to contract properly after delivery, leading to excessive bleeding.
  • Retained placental tissue: If the placenta or parts of it are not delivered after the baby is born, it can cause excessive bleeding.
  • Trauma to the birth canal: This can include tears, lacerations, or other injuries to the vagina, cervix, or perineum that can cause bleeding.
  • Uterine rupture: This is a rare but severe complication that can occur when the uterus tears during delivery, leading to excessive bleeding.
  • Coagulation disorders: Certain medical conditions or medications can affect blood clotting and increase the risk of bleeding.
  • Placenta accreta: This is a condition where the placenta attaches too deeply to the uterine wall, which can cause difficulty removing the placenta and lead to bleeding.
  • Infection: Infection of the uterus or birth canal can cause inflammation and lead to bleeding.
  • Overdistended uterus: This can occur in women who carry multiples or have a large baby, which can cause the uterus to become overstretched and lead to poor uterine contractions after delivery.

It's important to note that some women may be at a higher risk of PPH due to certain factors such as previous PPH, placenta previa, or medical conditions such as preeclampsia.

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Risk Factors of Postpartum Hemorrhage

Several risk factors can increase a woman's likelihood of experiencing postpartum hemorrhage (PPH). These include:

  • Previous history of PPH: Women who have previously experienced PPH are at a higher risk of experiencing it again in future pregnancies.
  • Prolonged or rapid labor: Labor that lasts longer than usual or progresses too quickly can increase the risk of PPH.
  • Induced or augmented labor: The use of medications to induce or speed up labor can increase the risk of PPH.
  • Multiple gestations: Women carrying more than one baby have a higher risk of postpartum hemorrhage.
  • Macrosomia: A baby larger than average (weighing over 4,000 grams) can increase the risk of PPH.
  • Placenta previa or placental abruption: These can cause bleeding during pregnancy and increase the risk of PPH.
  • Uterine fibroids or other uterine abnormalities: These conditions can affect the ability of the uterus to contract properly after delivery, increasing the risk of postpartum hemorrhage.
  • Cesarean delivery: Women who have a cesarean delivery are at a higher risk of postpartum hemorrhage than those who have a vaginal delivery.
  • Use of certain medications: Certain medications, such as oxytocin, can increase the risk of PPH.
  • Maternal age: Women who are older than 35 years old are at a higher risk of PPH.

Healthcare providers should be aware of these risk factors and monitor women at an increased risk of PPH closely during labor and delivery.

Complications

Postpartum hemorrhage (PPH) can lead to several complications, some of which can be life-threatening. Some of the possible complications of PPH include:

  • Anemia: Excessive blood loss can lead to anemia, which can cause fatigue, weakness, and other symptoms.
  • Shock: In severe cases of PPH, blood loss can cause shock, which can be life-threatening if not treated promptly.
  • Organ failure: Prolonged shock can lead to organ failures, such as kidney failure or liver failure.
  • Blood clots: Women who experience PPH are at an increased risk of developing blood clots, which can lead to complications such as pulmonary embolism.
  • Infection: Postpartum hemorrhage can increase the risk of infection if the bleeding is due to retained placental tissue.
  • Hysterectomy: In rare cases, postpartum hemorrhage may require a hysterectomy (removal of the uterus) to stop the bleeding.
  • Death: In very rare cases, severe postpartum hemorrhage can lead to death.

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Prevention

Postpartum hemorrhage is a severe condition that occurs when there is excessive bleeding after childbirth. Here are some ways to prevent postpartum hemorrhage:

  • Attend regular prenatal visits: It's important to attend regular prenatal visits to monitor your pregnancy and identify any risk factors for postpartum hemorrhage.
  • Manage underlying medical conditions: If you have any underlying medical conditions, such as diabetes or high blood pressure, it's important to manage them carefully during pregnancy.
  • Avoid induction of labor: Inducing labor increases the risk of postpartum hemorrhage, so it's best to avoid induction unless it's medically necessary.
  • Avoid multiple vaginal examinations: Multiple vaginal examinations during labor can increase the risk of postpartum hemorrhage. Try to limit the number of vaginal exams during labor.
  • Use active management of the third stage of labor: Active management of the third stage of labor involves the use of medications and controlled cord traction to deliver the placenta quickly and prevent excessive bleeding.
  • Consider early cord clamping: Early cord clamping may reduce the risk of postpartum hemorrhage by reducing the amount of blood in the placenta.
  • Be prepared for emergencies: It's important to have a plan in place for emergencies, such as postpartum hemorrhage. Make sure you know where the nearest hospital is and how to get there quickly if needed.

It's important to note that some women may still experience postpartum hemorrhage despite taking these preventive measures. If you experience excessive bleeding after childbirth, seek medical attention immediately.

 

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Diagnosis

Postpartum hemorrhage is diagnosed when there is significant blood loss after childbirth. The diagnosis is based on a combination of clinical symptoms and laboratory tests. Here are some ways to diagnose postpartum hemorrhage:

  • Clinical symptoms: The most common symptom of postpartum hemorrhage is excessive bleeding after delivery. Other symptoms may include a decrease in blood pressure, rapid heart rate, and paleness.
  • Physical examination: A healthcare provider will perform a physical examination to assess the amount of blood loss and check for any signs of trauma or injury.
  • Laboratory tests: Laboratory tests, such as a complete blood count and coagulation studies, can help to identify any abnormalities in blood cells or clotting factors that may contribute to postpartum hemorrhage.
  • Ultrasound: In some cases, an ultrasound may be used to evaluate the uterus and identify any retained placental tissue or blood clots that may be contributing to bleeding.

It's important to note that postpartum hemorrhage can be life-threatening and requires prompt medical attention. If you experience excessive bleeding after childbirth, seek medical help immediately.

Treatment of Postpartum Hemorrhage | When to Consult a Doctor

Postpartum hemorrhage is a medical emergency that requires prompt treatment. Here are some ways to treat postpartum hemorrhage:

  • Medications: Medications, such as oxytocin or misoprostol, may be used to help the uterus contract and prevent excessive bleeding.
  • Manual techniques: Manual techniques, such as uterine massage or compression, may be used to help the uterus contract and stop bleeding.
  • Surgical intervention: In some cases, surgical intervention may be necessary to stop bleeding. It may include procedures such as uterine artery ligation, uterine balloon tamponade, or hysterectomy.
  • Blood transfusion: If there is significant blood loss, a blood transfusion may be necessary to replace lost blood and improve oxygen delivery to the body's tissues.
  • Fluid replacement: Fluid replacement may be necessary to help maintain blood pressure and improve tissue perfusion.
  • Monitoring and observation: Close monitoring and observation are necessary to ensure that bleeding has stopped and to watch for any potential complications.

It's important to note that the treatment of postpartum hemorrhage will depend on the cause and severity of the bleeding. It's essential to seek medical attention immediately if you experience excessive bleeding after childbirth. You can get an appointment with a well-known gynecologist via Healthwire. 

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