Postpartum Hemorrhage: Causes, Risks, and Management
Postpartum hemorrhage (PPH) is a serious and potentially life-threatening condition that can occur after childbirth. It involves excessive bleeding following the delivery of a baby, defined as losing more than 500 mL of blood after a vaginal birth or more than 1,000 mL after a cesarean section.
Types of Postpartum Hemorrhage
- Primary (early) PPH – This type occurs within the first 24 hours after delivery.
- Secondary (late) PPH – This occurs between 24 hours and 12 weeks postpartum.
Causes of Postpartum Hemorrhage (The "Four Ts")
- Tone (Uterine atony) – This is the most common cause, where the uterus fails to contract effectively after delivery.
- Tissue – Retained fragments of the placenta or membranes contribute to bleeding.
- Trauma – Injury to the cervix, vagina, or uterus, such as tears or uterine rupture.
- Thrombin – Blood clotting disorders that hinder the body’s ability to control bleeding.
Risk Factors
While PPH can affect anyone, certain factors increase the risk:
- Prolonged or rapid labor
- Overdistended uterus (due to multiple pregnancies or a large baby)
- Placenta previa or placental abruption
- Use of certain medications, such as oxytocin for labor induction
- History of postpartum hemorrhage
- High blood pressure or clotting disorders
Signs and Symptoms
- Heavy vaginal bleeding
- A drop in blood pressure
- Increased heart rate
- Pale or cold skin
- Dizziness or fainting
- A uterus that feels soft or boggy
Diagnosis and Treatment
Management of PPH may include:
- Uterine massage to stimulate contractions
- Medications such as oxytocin, misoprostol, or ergometrine
- Removing retained tissue if necessary
- Surgical interventions like uterine packing, artery embolization, or hysterectomy in severe cases
- Blood transfusions to replace lost blood
Recovery and Support
Women who experience PPH may need extended hospital stays and emotional support. Counseling can be beneficial, especially if the event was traumatic.
Prevention and Monitoring
- Regular prenatal care to identify risk factors
- Skilled birth attendants
- Active management of the third stage of labor, such as administering oxytocin immediately after delivery
Conclusion
Postpartum hemorrhage is a medical emergency, but with prompt care, most women can fully recover. Awareness and timely intervention are crucial in saving lives and preventing complications.