Prevention And Management Of Postpartum Haemorrhage

What Is Postpartum Haemorrhage?

Severe bleeding after giving birth is known as postpartum haemorrhage (PPH). This condition is hazardous and terrible. PPH typically manifests within 24 hours of delivery, however, it can also appear up to 12 weeks after delivery. Early detection and prompt treatment of bleeding result in better outcomes.

Postpartum haemorrhage is defined as bleeding that is severe enough to result in symptoms of excessive blood loss or a significant change in heart rate or blood pressure following birth, regardless of whether it was a vaginal delivery or a Caesarean section.

How Does PPH Occur?

During pregnancy, your placenta connects to the uterine wall and feeds and oxygenates the developing foetus. Your uterus continues to contract after the birth of the baby in order to deliver the placenta. We refer to this as the third stage of labour.

The blood arteries where the placenta was linked to your uterine wall are likewise compressed by contractions. These contractions may not always be powerful enough to halt the bleeding (called uterine atony). Up to 80 per cent of postpartum haemorrhages are brought on by this.

Postpartum haemorrhage can also happen if parts of the placenta stay attached to your uterine wall or if parts of your reproductive organs are damaged during delivery. You’re at an increased risk for PPH if you have a blood clotting (coagulation) disorder or certain health conditions.

The uterus usually tightens once the baby is delivered and this will detach the placenta. The contraction will aid in compressing the bleeding vessels where the placenta was attached. If the uterus is unable to contract strongly, the blood vessels will bleed freely causing a haemorrhage to occur.

Types Of Postpartum Haemorrhage

There are two types of PPH. Primary postpartum haemorrhage occurs within the first 24 hours after delivery. Secondary or late postpartum haemorrhage occurs 24 hours to 12 weeks postpartum.

How Much Blood Loss Is Considered Postpartum Haemorrhage?

Regardless of whether the baby was delivered vaginally or via C-section, postpartum haemorrhage occurs when the total blood loss after delivery exceeds 32 fluid ounces, or when bleeding is severe enough to result in symptoms of excessive blood loss or a significant change in heart rate or blood pressure.

 About 4 per cent of women have a postpartum haemorrhage, and the chances of having it increase with a caesarean birth. Usually, postpartum haemorrhage occurs right after delivery, but it can occur later as well.

Postpartum Haemorrhage Causes

There are several causes of postpartum bleeding.

The causes of postpartum haemorrhage are called the four Ts (tone, trauma, tissue and thrombin).

The most common causes of PPH are:

• Uterine atony

Postpartum uterine atony, also known as uterine tone, describes a fragile and frail uterus. This occurs when the uterine muscles are not sufficiently contracted to seal the placental blood vessels. After delivery, this causes a constant loss of blood.

• Uterine trauma

Bleeding results from injury to your vagina, cervix, uterus, or perineum (region between your genitalia and anus). Your risk of uterine injuries can increase if you deliver the baby with forceps or vacuum extraction. A hematoma (gathering of blood) can occasionally develop in a hidden region and result in bleeding hours or days after delivery.

• Retained placental tissue

When the entire placenta remains attached to your uterine wall, this condition occurs. It’s typically brought on by placental disorders that impair your uterus’s capacity to contract after delivery.

• Blood clotting disorder (thrombin)

A coagulation problem or pregnancy disorder like eclampsia might affect your body’s ability to clot blood. Due to this, even a small bleed may become unmanageable.

How Serious Is Postpartum Haemorrhage?

A dangerous and sometimes lethal condition, postpartum haemorrhage. You can lose a lot of blood quickly if you have PPH. Blood pressure suddenly drops as a result, which may prevent your brain and other organs from receiving enough oxygen. This condition is known as shock, and it can be fatal.

A postpartum haemorrhage is a medical emergency that requires immediate attention.

What Increases The Risk Of Postpartum Haemorrhage Occurring?

There are many factors that increase the risk of postpartum haemorrhage. Here are a few of the most prominent ones:

• Delivery of a big baby
• Multiple pregnancies with prolonged labour
• Infection
• Obesity
• Medications that induce labour
• Using vacuum-assisted delivery or forceps
• Tear in the birth canal/ vaginal tissues/ uterine blood vessel
• An increased tendency to bleed easily due to a blood clot disorder
• Placental abruption. This is the placenta’s early separation from the uterus.
• Placenta previa. This occurs when the placenta is over or close to the cervix’s opening.
• An enlarged uterus. This occurs when a large baby or too much amniotic fluid cause the uterus to be larger than usual.
• Pregnancy-related high blood pressure conditions
• Having numerous prior births

Signs Of Haemorrhage After Birth

After birth, prolonged, heavy bleeding is the most typical sign of postpartum haemorrhage.

Indicators of PPH include:

• Signs of a blood pressure drop, such as lightheadedness, blurred vision, or feeling weak.
• A higher heart rate.
• Red blood cell count decline.
• Dull or cold skin.
• Vomiting or nauseous.
• A worsening of pelvic or abdominal pain.
• Swelling and pain in tissues around the vaginal area

The symptoms of postpartum haemorrhage may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

Tell your medical professionals the truth about how you’re feeling following delivery. Sometimes PPH symptoms don’t appear till after you’ve left the hospital. If you experience any of the aforementioned symptoms in the days or weeks following giving delivery, call your healthcare professional right away.

How to Prevent Postpartum Haemorrhage

Sometimes just by being more cautious and researching, you can really help in preventing a serious condition. Here are two ways to prevent postpartum haemorrhage

• Prior to delivery, if you’re anaemic seek help for it.
• Episiotomies, only if necessary

What Will The Doctor Do?

Ultimately every illness comes down to treatment. Here are some things that doctors will do in the case that you have a postpartum haemorrhage:

• Examine the uterus and pelvic tissues
• Prescribe medications such as prostaglandins, oxytocin or ergometrine
• Remove any remaining placenta pieces from the uterus
• Perform surgery that will enable to find the cause of bleeding. This surgery is known as laparotomy.
• Surgically remove the uterus. This is known as hysterectomy and is usually a doctor’s last resort when trying to resolve this condition.

Postpartum Haemorrhage Treatment

Most of the time, medical professionals handle PPH as an emergency. The objectives of treating postpartum haemorrhage are replenishing blood volume and halting the source of the bleeding as quickly as feasible.

Some of the remedies employed are:

• Uterine massage to assist your uterus’s muscles in contracting.
• Contractions-stimulating medication.
• Eliminating uterine tissue that has been retained after delivery.
• Fixing uterine, cervical, and vaginal rips or abrasions.
• Sterilized gauze packing or cutting off the blood veins in your uterus.
• Applying pressure to your uterine walls with the aid of a catheter or balloon.
• Embolization of the uterine artery.
• Transfusion of blood.
• A Foley catheter or a Bakri balloon to apply pressure to the uterine haemorrhage. The uterus may be filled with sponges and sterile materials, according to your healthcare practitioner. If neither a Bakri balloon nor a Foley catheter are accessible, this may be done.
• Laparotomy. This procedure involves opening the abdomen to identify the source of the bleeding.
• Closing or tying off blood vessels that are bleeding. Uterine compression sutures, specialised gel, adhesive, or coils are used for this. A laparotomy is used to do the procedure.
• Hysterectomy. This procedure removes the uterus. This is typically a final resort.

Treatment of postpartum haemorrhage involves replacing lost blood and fluids. To stop shock, you could receive IV (intravenous) fluids, blood, and blood products right away. Oxygen could be beneficial.

Haemorrhage after giving birth might be very dangerous. However, you frequently have a good chance of making a full recovery if your doctor detects and treats the cause of the bleeding early.

Emergency Situation

Numerous issues, including a faster heartbeat, shallow breathing, and reduced blood flow, can result from excessive blood loss. Shock can result from these symptoms because it can prevent blood from reaching your heart, liver, brain, or kidneys. Severe blood loss can cause the new mother’s blood pressure to fall considerably and this may even lead to shock and or death.

Sometimes postpartum haemorrhage is followed by Sheehan’s syndrome, a pituitary disorder.

However, early detection can lead to a successful recovery. So if you are experiencing the symptoms mentioned above after you have given birth, consult your healthcare provider without delay. 

Updates by Matt Doctor

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