Severe bleeding after childbirth (known as post-partum haemorrhage or PPH) is the leading cause of maternal death worldwide. More than 100,000 women globally die each year from the condition. Post-partum haemorrhage is defined as a blood loss of more than 500ml(vaginal Birth) or 1000ml(c-section) within 24 hours of giving birth. It usually happens within 1 day of giving birth, but it can happen up to 12 weeks after having a baby.
Warning Signs indicating you might have PPH:
You may have PPH if you have any of these signs or symptoms. If you observe any of these, go to the emergency immediately.
- Heavy bleeding from the vagina that doesn’t slow or stop
- Drop in blood pressure or signs of shock. Signs of low blood pressure and shock include blurry vision; having chills, clammy skin or a really fast heartbeat; feeling confused dizzy, sleepy or weak; or feeling like you’re going to faint.
- Nausea (feeling sick to your stomach) or throwing up
- Pale skin
- Swelling and pain around the vagina or perineum. The perineum is the area between the vagina and rectum.
RISK FACTORS
Some Women are more likely to have PPH. Having a risk factor doesn’t mean for sure that you will have PPH, but it may increase your chances. PPH usually happens without warning. Talk to your Doctor about what you can do to help reduce your risk for having PPH.
- You’re more likely than other women to have PPH if you’ve had it before.
- Asian and Hispanic women also are more likely than others to have PPH.
- Uterine Atony. This is the most common cause of PPH. It happens when the muscles in your uterus don’t contract (tighten) well after birth. Uterine contractions after birth help stop bleeding from the place in the uterus where the placenta breaks away. You may have uterine atony if your uterus is stretched or enlarged (also called distended) from giving birth to twins or a large baby (more than 8 pounds, 13 ounces). It also can happen if you’ve already had several children, you’re in labor for a long time or you have too much amniotic fluid.
- Uterine inversion. This is when the uterus turns inside out after birth.
- Uterine rupture. It is a very rare condition. This is when the uterus tears during labor. It may happen if you have a scar in the uterus from having a c-section in the past or if you’ve had other kinds of surgery on the uterus.
- Placental Abruption. This is when the placenta separates from the wall of the uterus before birth. It can separate partially or completely.
- Placenta accreta, placenta increta or placenta percreta. These conditions happen when the placenta grows into the wall of the uterus too deeply.
- Placenta previa. This is when the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina.
- Retained placenta. This happens if you don’t pass the placenta within 30 to 60 minutes after you give birth. Even if you pass the placenta soon after birth, your provider checks the placenta to make sure it’s not missing any tissue. If tissue is missing and is not removed from the uterus right away, it may cause bleeding.
- Having a c-section
- Getting general anesthesia. This is medicine that puts you to sleep so you don’t feel pain during surgery. If you have an emergency c-section, you may need general anesthesia.
- Taking medicines to induce labor. Providers often use a medicine called Pitocin to induce labor. Pitocin is the man-made form of oxytocin, a hormone your body makes to start contractions.
- Taking medicines to stop contractions during preterm labor. If you have preterm labor, your provider may give you medicines called tocolytics to slow or stop contractions.
- Tearing (also called lacerations). This may happen if the tissues in your vagina or cervix are cut or torn during birth.
- Having quick labor or being in labor a long time. Labor is different for every woman. If you’re giving birth for the first time, labor usually takes about 14 hours. If you’ve given birth before, it usually takes about 6 hours.
- Blood conditions, like von Willebrand disease or disseminated intravascular coagulation (also called DIC). Von Willebrand’s disease is a bleeding disorder that makes it hard for a person to stop bleeding. DIC causes blood clots to form in small blood vessels and can lead to serious bleeding. Certain pregnancy and childbirth complications (like placenta accreta), surgery, sepsis (blood infection) and cancer can cause DIC.
- Infection, like chorioamnionitis. This is an infection of the placenta and amniotic fluid.
- Obesity.
- Gestational hypertension or preeclampsia. High blood pressure of pregnancy.
Why is postpartum hemorrhage a concern?
Excessive and rapid blood loss can cause a severe drop in the mother’s blood pressure and may lead to shock and death if not treated.
How is postpartum hemorrhage diagnosed?
In addition to a complete medical history and physical examination, diagnosis is usually based on symptoms, with laboratory tests often helping with the diagnosis. Tests used to diagnose postpartum hemorrhage may include:
- Estimation of blood loss (this may be done by counting the number of saturated pads, or by weighing of packs and sponges used to absorb blood; 1 milliliter of blood weighs approximately one gram)
- Pulse rate and blood pressure measurement
- Hematocrit (red blood cell count)
- Clotting factors in the blood
Treatment for postpartum hemorrhage
The aim of treatment of postpartum hemorrhage is to find and stop the cause of the bleeding as quickly as possible. Treatment for postpartum hemorrhage may include:
- Medication (to stimulate uterine contractions)
- Manual massage of the uterus (to stimulate contractions)
- Removal of placental pieces that remain in the uterus
- Examination of the uterus and other pelvic tissues
- Bakri Postpartum balloon or a Foley catheter to compress the bleeding inside the uterus. Packing the uterus with sponges and sterile materials may be used if a Bakri balloon or Foley catheter is not available.
- Tying-off of bleeding blood vessels using uterine compression sutures
- Surgery to open the abdomen to find the cause of the bleeding.
- Surgical removal of the uterus; in most cases, this is a last resort.
- Replacing lost blood and fluids is important in treating postpartum hemorrhage. Intravenous (IV) fluids, blood, and blood products may be given rapidly to prevent shock. The mother may also receive oxygen by mask.
The symptoms of postpartum hemorrhage may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.
