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Postpartum Haemorrhage (PPH): Symptoms, Causes and Treatment

Labour and childbirth is a painful process for a mother. But even after delivering the baby, she is not completely safe. She might encounter many of the health issues. Some of those are Postpartum haemorrhage, Postpartum eclampsia, postpartum hypertension, postpartum depression. Although all the above conditions could disturb a mother’s life in the way she never imagines, Postpartum haemorrhage or PPH could cause even death. It is one of the major obstetrical emergencies and also, one of the main reasons for maternal morbidity and mortality in the world. So, what is PPH? What causes it? What are the symptoms? How to treat it? How to prevent it? - We have provided all the needed information below. Read on.

Table of Contents:

What is haemorrhage?

What is PPH (Postpartum Haemorrhage)?

What may cause Postpartum Haemorrhage

Symptoms of Postpartum Haemorrhage

How to diagnose PPH?

Treatment of Postpartum Haemorrhage

What is Haemorrhage?

Before knowing more about the PPH pr postpartum haemorrhage, we need to understand what is haemorrhage and here is the needed information about it.

Haemorrhage or also called as bleeding is the term used to describe the blood loss. It could be internal (where the blood loss is inside the body) or external (where the blood loss is outside the body). Inside bleeding could happen in any part of the body such as liver, brain, spleen and other parts due to the damaged blood vessel or organs whereas the external bleeding could happen due the break in the skin or even through the natural opening in the body such as in mouth, nose, vagina, rectum.

PPH or postpartum haemorrhage is also one of the types of haemorrhage.

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What is PPH (postpartum haemorrhage)?

PPH or Postpartum haemorrhage is a condition in which there will be a rapid loss of a large amount of blood. According to WHO, if the amount of blood lost after labour is greater than 500 ml, it is called postpartum haemorrhage (PPH). It could lead to the death of the mother post-delivery. PPH is more common in Cesarean section delivery than the normal one.

The contributors to the postpartum haemorrhage are the intensive blood flow and large wound surface caused after the delivery. Although the woman's body is designed to bear the tolerable blood loss during delivery (which is up to 0.5% of total body weight), an excessive loss could lead to the death of the mother. The severity of the PPH could be determined based on the amount of the blood lost.

Ideally, after the delivery, the postpartum haemorrhage or PPH from the uterine wound is prevented by the increase in uterine muscle contractions, displacement into deeper muscle layer of uterine arteries, activation of the coagulation system and by the formation of thrombus in the small vessels. But when this whole system or a part of this system fails, the excessive bleeding through birth canal occurs.

Postpartum haemorrhage can occur in early or later stages after childbirth, just like postpartum eclampsia. In the early stages, PPH occurs within the first 2 hours. Later postpartum haemorrhage can develop anytime between 2 hours to 6 weeks after the child birth.

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What May Cause Postpartum Haemorrhage

 

The causes of PPH are described as 4 Ts: Tone, Trauma, Tissue and Thrombin.

Uterus without muscle tone or Uterine Atony: After delivery, the uterus generally contracts and pushes out the placenta out and after that, the contractions put pressure on the damaged vessels where the placenta was attached and stops the bleeding. If the contractions are not strong enough, the blood vessels could bleed freely causing postpartum haemorrhage. The reason for this loss of muscle tone could be: Older aged mother, Overly enlarged uterus due to twins or triplet babies, anemia, malnutrition, prolonged labour.

Trauma:

One of the other reasons for heavy bleeding after delivery is - if there is extreme trauma to the genital tract (cervix, vagina, perineum, uterine) during childbirth, there is a rupture that could cause bleeding and in turn, lead to PPH.

Tissue:

In case, after delivering the baby and pushing out the placenta, if the bits of the placenta is still attached, it causes bleeding after delivery

Thrombin:

Thrombin helps in coagulation of the blood at the wounded site. In some cases, where the mother is suffering from coagulation disorders, there will be heavy bleeding after delivery causing postpartum haemorrhage.

Drugs:

There are a few drugs such as Ritodrine, Nifedipine which induces Postpartum Haemorrhage.

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Symptoms of Postpartum Haemorrhage:

The very common symptoms of Postpartum Haemorrhage (PPH) are:

 - Foremost sign of PPH is bleeding or haemorrhage after delivery.

 - Bleeding is usually slow trickle from the vagina.

 - The bleeding is uncontrollable and excess.

 - Fall in blood pressure and high pulse rate in severe cases.

 - Drop in blood cells count

 - Decrease in blood volume causing the associated anaemia along with hypovolemic shock.

 - Increase in heart rate

 - Pain and swelling around the vaginal area and constant bleeding due to a hematoma.

 - Nausea

 - The skin could become pale due to extreme loss of blood.

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How to diagnose PPH?

The Postpartum Haemorrhage is diagnosed by checking the history of bleeding along with conducting the physical examination, In case of PPH, during the physical examination, the uterus can be felt easily in the lower abdomen, the low blood pressure and high pulse rate could be determined. The further test of blood could reveal the low haemoglobin count confirming PPH.

The blood test report could disclose the following information:

The estimation of the amount of blood lost

Pulse and blood pressure report

Red blood cell count

Other clotting factors in the blood.

Postpartum Haemorrhage Treatment:

Postpartum Haemorrhage treatment needs an integrated approach - Finding the cause of heavy bleeding after delivery, stopping the bleeding, preventing the blood loss, restoring the needed volume of circulating blood in the body and stabilizing the blood pressure level.

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The postpartum haemorrhage treatment includes the following:

One of the postpartum haemorrhage treatment includes stimulating the uterine contractions with the help of medicines or by uterine massaging or by bimanual compression.

If the bits of the placenta is still attached to the uterus, removing them.

Examining the genital tract to determine the damaged areas to repair.

Using a Bakri balloon or a Foley catheter to pressurize the bleeding site inside the uterus. In case, they are not available, the healthcare professional may prefer to pack the uterus with sponges and sterile materials.

Laparotomy:

Opening the abdomen surgically to find the cause of heavy bleeding after delivery. Treating the bleeding blood vessels by tying off or sealing with the help of uterine compression sutures, glue or coils.

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Hysterectomy:

It is the last resort when none of the above could help. In this method, a surgery is conducted to remove the uterus.

Aforesaid, replacing the lost blood and maintaining the fluid is utmost important while treating PPH. So, as a part of postpartum haemorrhage treatment, the patient might be given Intravenous fluids, blood transfusion and other blood products.

Giving birth to a baby is no easy task. The period after delivery is not easy either. Along with sleepless nights, fatigue and breastfeeding, if conditions like Postpartum Haemorrhage accompanies you, it would be a nightmare. So, if you notice heavy bleeding after delivery (in early stage or later stage), consult your doctor immediately and get the required treatment.

 

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