Postpartum Hemorrhage

12 Aug

Postpartum Hemorrhage

Postpartum Hemorrhage

Postpartum Hemorrhage (PPH) is a serious condition where a woman has heavy bleeding after giving birth. Around 4% of women experience this condition which mainly occurs in cesarean births. Blood loss in normal delivery is about 500 ml whereas, in cesarean delivery, it is approximately 1000 ml. Postpartum Hemorrhage can be detected when the blood loss is more than the estimated 1000 ml.

Postpartum Hemorrhage happens after the placenta is delivered; however, it can also occur later. It can significantly lower blood pressure leading to shock or even death if not treated immediately.

Causes of Postpartum Hemorrhage

After a baby’s delivery, the uterus contracts for pushing out the placenta, which is attached to the area of bleeding vessels. When the contractions are strong enough, these vessels bleed more, leading to Postpartum Hemorrhage. It can also occur if small pieces of the placenta remain attached. PPH may also be caused by:

Tear in the blood vessel in the uterus
Tear in the cervix/tissues of the vagina
Blood clotting disorders
Being in labour for more than 14 hours or less than 6 hours
Taking medicines for inducing labour for stopping contractions for preterm labour
General anaesthesia
Infections
Bleeding into a concealed tissue area or pelvis resulting in a hematoma
Conditions affecting the uterus such as uterine atony, uterine inversion or rupture
Issues in the placenta such as placenta accreta, placenta increta and placenta percreta

Symptoms and Diagnosis of Postpartum Hemorrhage

Some of the Postpartum Hemorrhage symptoms include:

Uncontrolled/heavy bleeding
Increased heart rate
Decrease in blood pressure
Reduction of red blood cell count
Nausea and pale skin
Swelling and pain in tissues in the perineal and vaginal area

Postpartum Hemorrhage diagnosis can be done by:

Estimating the amount of blood loss
Observing red blood cell count by conducting blood tests
Clotting factors in the blood
Measuring blood and pulse pressure
Ultrasound for checking issues in placenta or uterus
Pelvic exam for checking vagina, cervix and uterus

Treatment for Postpartum Hemorrhage

The impact of Postpartum Hemorrhage is more significant for some women than others. Therefore, PPH treatment is essential, which may include:

Removing remaining pieces of the placenta from the uterus by using gauze or sponges or using medical tools
Examining uterus and pelvic tissues
Conducting surgery such as laparotomy (source of bleeding is checked) or hysterectomy (the uterus is removed)
Stitching bleeding blood vessels
Administrating medicines such as Pitocin, Oxytocin or Intravenous (IV) fluids
Conducting blood transfusion for managing the blood loss
Providing oxygen using an oxygen mask
Taking extra iron supplements or prenatal vitamins
Messaging the uterus by hand for lessening the bleeding and passing out blood clots

Postpartum Hemorrhage is a critical condition required to be quickly detected and treated so that the mother can make a full recovery. Having emergency care available can always prove to be helpful at the time of delivery where such conditions can be managed efficiently. Calling or visiting healthcare institutions is also crucial if PPH occurs after you have been discharged.

References

https://www.stanfordchildrens.org/en/topic/default?id=postpartum-hemorrhage-90-P02486

https://childrenswi.org/medical-care/fetal-concerns-center/conditions/pregnancy-complications/postpartum-hemorrhage

https://www.marchofdimes.org/pregnancy/postpartum-hemorrhage.aspx