Postpartum hemorrhage is defined as excessive bleeding after childbirth caused by inadequate uterine contractions and leads to shock and death if not treated.
If you are pregnant or know someone pregnant, it’s important to be aware of postpartum hemorrhage.
Postpartum hemorrhage is a serious complication that can occur after childbirth. In this blog post, we will discuss the causes and symptoms of postpartum hemorrhage, as well as treatment options. We hope that this information will help you to be better prepared for this potential complication.
What is postpartum hemorrhage?
Postpartum hemorrhage (PPH) is defined as excessive bleeding after childbirth. It is the most common cause of maternal death worldwide. It is most likely to occur due to inadequate uterine contractions. PPH affects between 1 and 5 out of every 100 women who give birth (1-5 percent).
Postpartum hemorrhage is a problem that can happen to some women after they have a baby. This problem is more likely to happen if you have a cesarean birth. It often happens after the placenta is delivered, but it can also happen later on.
What are the causes of postpartum hemorrhage?
Some of the more common causes include:
Uterine atony: This occurs when the uterus does not contract properly after childbirth. After the placenta is delivered, these contractions help compress the bleeding vessels in the area where the placenta was attached.
If the uterus does not contract strongly enough, these blood vessels bleed freely and can cause the bleeding to become uncontrolled. The following are conditions which interfere with uterine contraction and retraction are:
- Grand multipara: A woman who has given birth four or more times
- Macrosomia: A baby who is larger than average
- Polyhydramnios: Excess amniotic fluid
- Malnutrition and anemia
- Multiple pregnancies
- Prolonged labor
- Uterine fibroids
- The mismanaged third stage of labor
- Blood clotting disorders
Lacerations: Lacerations of the vagina, cervix, or perineum can all lead to postpartum hemorrhage.
Placenta accreta: This is a condition where the placenta attaches too deeply to the uterine wall. This can cause severe bleeding after the delivery of the placenta.
Retained placenta: If the placenta is not delivered within 30 minutes after the baby is born, it is considered retained. This can cause excessive bleeding.
Most postpartum hemorrhage occurs right after the placenta is delivered.
Who is at risk for postpartum hemorrhage?
Conditions that may increase the risk for postpartum hemorrhage include the following:
- Placental abruption: The early detachment of the placenta from the uterus.
- Placenta previa. The placenta covers or is near the cervical opening.
- Overdistended uterus: Excessive enlargement of the uterus due to too much amniotic fluid or a large baby.
- Uterine inversion: This is a rare condition that can happen to some women after they have given birth when the uterus turns inside out after birth.
- Uterine rupture: This is when the uterus tears during labor.
What are the types of postpartum hemorrhage?
There are two types of PPH.
Primary postpartum hemorrhage occurs within the first 24 hours after delivery.
Secondary or late postpartum hemorrhage occurs 24 hours to 12 weeks postpartum.
What are the symptoms of postpartum hemorrhage?
The most common symptom of postpartum hemorrhage is uncontrolled bleeding. You may also experience other symptoms, such as:
- Shortness of breath
- Rapid heartbeat
- Low blood pressure
- Decreased RBC count
- Swelling and pain in the vaginal and perineal area
The symptoms of postpartum hemorrhage may look like other health conditions. If you experience any of these symptoms, it’s important to seek medical help immediately.
How is postpartum hemorrhage diagnosed?
Postpartum hemorrhage is diagnosed by checking for vaginal bleeding after the delivery of the baby. If there is excessive bleeding, a blood transfusion may be necessary.
Your health care provider will take a health history, do a pelvic exam to check your vagina, uterus, and cervix, and a physical exam.
Some tests can be done to check for postpartum hemorrhages, such as a blood count, a clotting time test, and measuring pulse and blood pressure, clotting factors in the blood.
Ultrasound Scanning can be used to look for issues with the placenta or uterus. Ultrasound is an imaging technique that uses sound waves to create an image of the inside of your body.
How to prevent postpartum hemorrhage?
There are a few things that you can do to help prevent postpartum hemorrhage.
- Improvement of the health status and keeping the hemoglobin levels up during pregnancy is the most important thing you can do.
- Prenatal care and healthy diet help to keep the hemoglobin levels up. You can also take iron supplements during pregnancy.
- If you have a cesarean delivery, ask your doctor about having a uterine tonic such as misoprostol. This will help by decreasing the risk of uterine atony.
- High-risk cases are to be screened and delivered in an equipped hospital.
- Slow delivery of the baby, controlled cord traction, and uterine massage.
- The use of low-dose oxytocin infusion is recommended for the prevention and treatment of postpartum hemorrhage.
- It is important to deliver the placenta as soon as possible after the birth of the baby.
- You should also avoid any vaginal birth after cesarean deliveries.
- Make sure that you are getting enough rest and eating a nutritious diet. This will help your body to heal and recover after childbirth.
- Avoid any strenuous activity for at least the first six weeks after delivery.
- Take care of your perineal area by doing a perineal massage and using a perineal sitz bath.
- Make sure to follow up with your healthcare provider to ensure that everything is healing properly.
If you are hemorrhaging after delivery, the first thing you should do is call your doctor or midwife. They will be able to give you instructions on what to do next.
What are the complications of postpartum hemorrhage?
Postpartum hemorrhage can lead to several complications, including:
- Uterine rupture
- Organ damage
It is important to get medical help as soon as possible if you are experiencing any of these symptoms.
What is the prognosis for postpartum hemorrhage?
Most women who experience postpartum hemorrhage will recover without any long-term complications. However, some women may experience more serious complications, such as infection or organ damage.
In rare cases, postpartum hemorrhage can be fatal. If you are experiencing any of the symptoms listed above, it is important to get medical help as soon as possible.
How is postpartum hemorrhage treated?
After the placenta is delivered, the uterine contractions help compress the bleeding vessels in the area where the placenta was attached. If the uterus does not contract strongly enough, a woman may need medication to help the uterus contract or she may need surgery to remove the remaining placenta or clot.
Treatment for postpartum hemorrhage will depend on the cause and severity of the bleeding. The most common treatment options include:
- Uterine massage: This is done to help the uterus contract and stop the bleeding.
- IV fluids: This is done to help prevent shock.
- Blood transfusion: This is done for replacing lost blood.
- Medication: This is done to help the uterus contract and stop the bleeding.
- Manual removal of the placenta: This is done if the placenta is not delivered after the baby is born.
- Bimanual compression: This is done to put pressure on the uterus and stop the bleeding.
- Removing any remaining pieces of the placenta from the uterus, packing the uterus with gauze, a special balloon or sponges, or using medical tools or stitches to help stop bleeding from blood vessels.
- Embolization of the blood vessels that supply the uterus.
- Surgery: This is done in severe cases where the bleeding cannot be stopped. A hysterectomy or a laparotomy may be needed.
Replacing lost blood and fluids is important in treating postpartum hemorrhage. The mother may also receive oxygen by mask. Postpartum hemorrhage can be quite serious. However, quickly detecting and treating the cause of bleeding can often lead to a full recovery.
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.