Symptoms of Postpartum Hemorrhage: How to recognise, respond, and recover from the condition
Postpartum hemorrhage is excessive bleeding after childbirth, usually over 500 ml. Causes include uterine atony, trauma, retained tissue, and clotting problems. Risk factors are multiple pregnancies, prolonged labour, and uterine abnormalities.
Definition and Impact of Post-Partum Haemorrhage During vaginal birth, there is approximately 500 millilitres of blood lost. Amount of blood lost in excess of 500 millilitres following the birth of the baby is termed post-partum haemorrhage (PPH). This can adversely affect the condition of the mother as seen by a rise in pulse rate and a reduction in blood pressure (Images: Canva)
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Timing of Primary Post-Partum Haemorrhage Primary post-partum haemorrhage occurs within twenty-four hours of birth of the baby, usually within only two hours. It can occur either before or after the expulsion of placenta, the temporary organ that acts as a facilitator of nutrients and gases to the foetus from the mother during gestation.
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Causes of Bleeding after Placental Separation When the placenta separates, the small uterine veins are torn and cannot be compressed properly, which leads to continuous bleeding. There are multiple factors that can potentially lead to post-partum haemorrhage. An atonic uterus, trauma, retained tissues or problems in blood clotting can cause PPH.
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Grand Multiparity and its Role in PPH A grand multiparity refers to a woman who has had five or more pregnancies that lasted beyond 20 weeks of gestation. Multiple childbirths can cause inadequate retraction and lead to the placenta becoming adherent to the uterine wall. Associated problems like reduced haemoglobin levels also contribute to PPH.
Grand Uterine Overdistension and Malnutrition Multiple pregnancies, excessive amniotic fluid or a big baby (weighing more than four kilograms) can cause extra distension of the uterus, and imperfect retraction are other causes of post-partum haemorrhage. Alongside, malnutrition in mothers can lead to excessive bleeding after delivery of the baby.
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Prolonged Labour and Anaesthetic Effects Labour that lasts for more than twelve hours, called prolonged labour, is also a contributing factor along with infection in the amniotic fluid and dehydration. Anaesthesia may be given during delivery, but some anaesthetic agents like ether or halothane can cause atonicity of the uterus, thus leading to haemorrhage.
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Placental Implantation Abnormalities and Labour Management Implantation of the placenta in malformations of the uterus like a septate or bicornuate uterus are also etiological factors for post-partum haemorrhage. Inadequate hospital management of the third stage of labour like prematurely trying to remove the placenta before it has separated, kneading the uterus or pulling the cord can cause bleeding.
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Surgical and other Risk Factors for PPH Blood loss due to operative delivery, episiotomy wound or cesarean delivery should not be ignored. If bits of placenta or even blood clots are left in the uterus, they can cause inadequate uterine retraction, thus leading to excessive bleeding. Obesity, previous history of PPH and age more than forty years can also be contributing factors.
How to Prevent Post-Partum Haemorrhage Post-partum haemorrhage can be prevented by improving the nutritional and health status of the mother, and by making certain that her haemoglobin levels do not fall below normal. Patients who have a high risk of PPH like women who have twins in the womb or have had multiple childbirths should be timely screened to avoid complications.
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Post-Delivery Monitoring and Management Observation of the mother for about two hours after delivery is necessary to confirm that the uterus is well contracted and hard before the woman is shifted to the ward. Skilled supervision and prompt action after detection can help in adequately managing post-partum haemorrhage. (Disclaimer: This article, including health and fitness advice, only provides generic information. Don’t treat it as a substitute for qualified medical opinion. Always consult a specialist for specific health diagnosis)
Rajeshwaari Kalla is a freelance health and wellness writer
