Postpartum hemorrhage: symptoms, causes, risk factors & treatment

PPH is abbreviated as postpartum hemorrhage. The bleeding occurring in the birth canal of mother within ten days after delivery, even with normal delivery or cesarean section is called as postpartum hemorrhage. If not treated Postpartum hemorrhage is a life threatening complication, leads to shock and even death of mother if proper medical care is not given. The blood loss in Postpartum hemorrhage is greater than 500 ml in normal delivery and more than 1,000 ml in cesarean section delivery.

Postpartum Hemorrhage Facts

  • Usually 1 to 10 % of pregnant mothers experience postpartum hemorrhage after delivery, according to american statistics.
  • Haemorrhage can occur before placental delivery or after placental delivery.
  • Postpartum hemorrhage leads to severe maternal morbidity and mortality.
  • 17% maternal mortality is due to Postpartum hemorrhage.
  • If bleeding is continuous, surgical intervention is needed to treat postpartum hemorrhage.
  •   Asian women have high incidence of postpartum hemorrhage.
  •   Postpartum hemorrhage occurs in women of child bearing age.

Postpartum Hemorrhage Causes

Uterine atony

 It is the main cause of postpartum hemorrhage. Uterine corpus is improperly constricted in case of uterine atony. Risk factors of uterine atony are

1) Overdistended uterus : Due to  multiple gestation, fetal macrosomia, hydramnios etc.
2) Fatigued uterus : Because of augmented or prolonged labor, amnionitis.
3) Obstructed uterus : caused due to  retained placenta or fetal parts, placenta accreta.

Uterus trauma

injury to uterus continuity, trauma of cervix, or birth canal, etc causes postpartum hemorrhage. Uterus trauma causes are:-

1) Delivery of a large infant ( baby with large head)
2) Instrumental delivery or intrauterine manipulation (using of  forceps, vacuum extraction of baby using ventous)
3) normal birth after cesarean section (VBAC)
4) Episiotomy

  • Blood coagulation disorders such as thrombocytopenia, may present before pregnancy or occur during labor
  • Uterine inversion, uterine rupture also causes  postpartum hemorrhage.
  • Drugs used to induce labor,
  • Prolonged labour,
  • Infection of birth canal at the time of labor,
  • Obesity of pregnant mother, etc are the causes postpartum hemorrhage.

Postpartum hemorrhage risk factors

  • Preeclampsia
  • Previous history of postpartum hemorrhage,
  • Asian or Hispanic ethnicity
  • Nulliparity or multiparity of pregnant mother.

Symptoms of Postpartum haemorrhage

  • Uncontrolled bleeding from birth canal,
  • Decrease in  blood pressure,
  • Increased heart beat rate,
  • Decreased  red blood cell count,
  • Swelling and pain in tissues of perineal area and birth canal,

Treatment of postpartum hemorrhage

Treatment of postpartum hemorrhage is given after the careful assessment by the physician or Obstetrician.

  • Nature of  pregnancy, health status of mother and medical history of pregnant mother,
  • Duration and extent of Hemorrhage,
  • Medications taken by the mother, procedures such as instrumental delivery, or any secific therapies.

The aim of treating  postpartum hemorrhage is to stop bleeding or hemorrhage as early as possible. Treatment for postpartum hemorrhage are

  • Examine uterus for any injury or to find uterus atony.
  • Medications to induce  uterine contraction.
  • Massage of Uterus manually, as it stimulates uterine contractions.
  • Pack the uterus with sterile sponges stop Hemorrhage.
  • Remove the part of placenta attached to uterus in case of incomplete placental delivery.
  • Ligation of bleeding blood vessels,

Laporatomy : Abdomen is opened and visualized for any uterus damage to find out the cause of postpartum hemorrhage.

Hysterectomy : is the term used for removal of uterus when all the remedial measures fail to stop postpartum hemorrhage.

Blood transfusion to restore the blood lost during hemorrhage.

Administer I V fluids, nearly 2000 to 2500 ml in the first day after delivery.

Treat Shock with administration of electrolytes and fluids.

Administer oxygen to mother  if  needed.

All the measures should be taken to restore the health of mother and to save the life of the mother.

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