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Postpartum Hemorrhage: Symptoms, Treatment And Prevention

4 min read

Although birthing is considered to be a divine and beautiful process, there is bound to be some amount of blood loss during the entire process. The blood loss incurred in normal vaginal birth is said to be a little more than what you can expect in cesarean delivery. In some rare cases, some women tend to have excessive blood flow during birthing, which leads to bleeding, and immediate medical intervention is required. This is a severe condition that could be fatal to the mother’s life. Read on to understand the causes, symptoms, treatment that will be provided for postpartum hemorrhage.

What Is Postpartum Haemorrhage (PPH)?

It is normal to lose blood following the delivery. And compared to the vaginal birth, after a c section, women lose more blood, which is also quite reasonable. An excessive loss of blood during childbirth is known as postpartum hemorrhage. In case of vaginal birth, more than 500 ml of blood loss and in case of C-section, more than 1500 ml of blood loss is considered to be dangerous. It can bring about an extreme drop in blood pressure. Without prompt treatment, this can pave the way for shock and death.
There are two stages to PPH, primary and secondary. Blood loss, which occurs within 24 hours of delivery, is primary, and that occurs between 24 hours to 12 weeks after the delivery is secondary. Primary is the most common type of PPH. You will be administered antibiotics through IV. A small surgery will be done to remove any blood clots, infections, or placenta pieces that may still remain in your uterus, causing PPH.

What Are The Symptoms Of Postpartum Haemorrhage?

Symptoms of PPH that can be noticed are;

  • Drop in the RBC count
  • Excessive bleeding
  • Swelling and pain in the perineal region or vagina
  • A decrease in blood pressure
  • Skin turning pale
  • Feeling of restlessness
  • Feeling weak and light-headed
  • Confusion
  • Increase in heart rate
  • Feeling unconscious

What Are The Risk Factors Of PPH?

Certain risk factors increase one’s chances of experiencing postpartum hemorrhage. However, please note that having a risk factor doesn’t mean you will bump into PPH, but it inevitably increases your chances. Under the below circumstances, you will more likely face PPH;

  • If you are pregnant post the age of 40
  • If you have a history of PPH
  • Preeclampsia or gestational hypertension
  • Placenta Abruption
  • Placenta Previa
  • Multiple pregnancies
  • Enlarged uterus due to excess amniotic fluid
  • If baby weight is more than 4kg
  • Long labor time
  • Bacterial infections
  • Labour inducing medicines
  • Assisted deliveries
  • Stillbirths
  • BMI of 35 or more before delivery

What Are The Causes Of Postpartum Haemorrhage?

In spite of the above-explained risk factors, several health issues increase the chances of PPH. Some of the common reasons why PPH occurs are;

Uterine Atony (tone):

This is the most common reason for PPH. Usually, after the placenta breaks away, the uterine muscle will markedly contract, thereby stopping the bleeding from the point where the placenta was attached. Uterine atony is a condition in which the uterine wall fails to contract, thus, resulting in excessive bleeding. Uterine Atony often happens when the uterus is stretch too much due to:

  • Prolonged labor
  • Delivering twins or triplets
  • Delivering big baby
  • More than three deliveries
  • Too much amniotic fluid

2. Trauma:

Any birth-related traumas such as episiotomy, Hematomas, Uterine inversion, Uterine rupture, etc. can cause PPH.

3. Retained Placenta:

The placenta ought to pass within 30 to 60 minutes after delivery. If this does not happen, it can cause PPH. Also, if some tissue of the placenta is retained inside and if not removed promptly, it can lead to PPH.

4. Thrombin (Blood clotting disorder):

Thrombin is a disorder where the blood clot does not happen quickly. This can lead to substantial blood loss after delivery, resulting in PPH.

How Is Postpartum Haemorrhage Diagnosed?

There are several ways PPH can be diagnosed;

  • Physical examination of cervix, perineum, vagina, and uterus
  • Blood tests to check RBC count
  • Blood clot observation test
  • Pulse and BP monitoring
  • Blood loss measurement by saturated pads and sponges used
  • Ultrasound
  • Angiography

How Is Postpartum Haemorrhage Treated?

Treatment is provided depending on the cause and severity of PPH;

  • Blood transfusions in case of severe bleeding
  • Bimanual uterine massage
  • Medicines to decrease blood flow
  • Trauma repair, in the case of episiotomy, uterine inversion or uterine rupture
  • Manual removal of placental tissue that remains inside.
  • In the case of massive PPH, appropriate surgeries will be initiated to find and correct the cause of excessive bleeding. Even hysterectomy will be performed as a last resort.

How Can Postpartum Haemorrhage Be Prevented?

After delivery, certain precautions can be taken to avoid any future incidents of PPH. Some of the effective interventions to prevent PPH are;

  • Administration of Uterotonics, which is very effective in inducing labor and also bringing down the chances of PPH.
  • Controlled cord traction, which refers to the pulling the umbilical cord while applying an opposing pressure. This will facilitate placental expulsion. However, it should be performed by an expert. This is because premature cord traction (pulling it from the uterine wall before the placenta naturally detaches itself) can bring about excessive blood loss.
  • Uterine massage
  • Administration of oxytocin to reduce blood flow in the vaginal delivery
  • Consuming iron supplements to constrict blood flow in case of Anaemia during pregnancy
  • In case of subsequent pregnancy were in the previous was a C-section, the doctor will check the position of the placenta. Placenta expulsion can be difficult if it is attached to the scar from the previous delivery.
  • In the case of disorders like blood clotting, treatment for the same is included in the delivery, such as the replacement of suitable blood components, administration of medicines to promote blood clots, support for intravascular volume, etc.

What Happens After A Postpartum Haemorrhage?

After the treatment for PPH and once the bleeding is bought under control, you will be closely observed. Some blood tests will be done to check blood clots, BP, and output of urine will be measured, and signs for internal bleeding will be checked. If the doctor detects no further risk in your condition, then you will be shifted to your personal ward.

Can You Experience Postpartum Haemorrhage If You Had It Before?

If you have faced PPH earlier, then the risk of you facing it again is much more. This condition is quite repetitive if it occurred once. Appropriate blood tests are done to check for PPH symptoms and signs.
Although postpartum hemorrhage sounds scary, with the advancement in modern medicine and pharmacology, there have been various effective solutions to prevent and treat PPH disorders. If you have experienced PPH before and have a few wise words to say to fellow moms-to-be about this condition, please comment below with your experience!

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