Postpartum haemorrhage (PPH) is a serious and potentially life-threatening condition that occurs after childbirth. It is defined as excessive bleeding following the delivery of a baby. PPH can lead to significant complications, including shock, organ failure, and even death, if not managed effectively. It’s important for new mothers and doctors to be aware of the causes, signs, and treatments of postpartum haemorrhage.
Causes of Postpartum Hemorrhage
PPH can be caused by several factors, often categorized into four T’s: Tone, Trauma, Tissue, and Thrombin.
- Uterine Atony: The most common cause of PPH is uterine atony, where the uterus fails to contract properly after delivery. When the uterus doesn’t contract effectively, blood vessels at the site of placental attachment do not close, leading to excessive bleeding. This condition is more likely to occur after prolonged labor, overdistention of the uterus (due to multiple pregnancies or large babies), or the use of certain medications during labor.
- Trauma: Trauma during delivery, such as vaginal tears, cervical lacerations, or uterine rupture, can cause significant bleeding. These injuries may occur during a complicated or assisted delivery, especially if forceps or a vacuum is used. Hematomas, or pockets of blood that form in the tissues can also cause persistent bleeding after childbirth.
- Retained Placental Tissue (Tissue): Sometimes, parts of the placenta remain inside the uterus after delivery, a condition known as retained placenta. The remaining tissue prevents the uterus from contracting entirely, leading to continued bleeding. This can happen if the placenta fails to detach properly or if pieces remain in the uterine wall.
- Coagulation Disorders (Thrombin): Although rare, blood clotting disorders can contribute to postpartum haemorrhage. Conditions like haemophilia can result in prolonged and excessive bleeding after birth.
Symptoms of Postpartum Hemorrhage
The signs of postpartum haemorrhage can range from mild to severe. Early signs include:
- Heavy vaginal bleeding (more than expected after delivery)
- Rapid heart rate or a drop in blood pressure
- Paleness or cold, clammy skin
- Dizziness or fainting
- Large blood clots passed during or after delivery
- Decreased urine output (a sign of blood loss affecting kidney function)
It’s important to note that not all bleeding after childbirth is abnormal, but if any of these signs are present, immediate medical attention is necessary.
Treatment for Postpartum Hemorrhage
Treatment for postpartum haemorrhage depends on the underlying cause and the severity of the bleeding. These include the following.
- Uterine Massage and Medication
If uterine atony is suspected, doctors will begin by massaging the uterus to stimulate contractions. Medications are often administered to help the uterus contract and reduce bleeding. Other medications may be used to further stimulate uterine contractions.
- Surgical Intervention
In cases where the bleeding does not stop with medication or uterine massage, surgical intervention may be required. This can include manual removal of retained placenta, repairing lacerations or uterine ruptures, or even performing a hysterectomy in extreme cases to save the mother’s life.
- Blood Transfusions
If a mother has lost a significant amount of blood, a blood transfusion may be necessary to replace the lost blood volume and stabilize her condition.
Conclusion
Postpartum haemorrhage is a critical condition that requires prompt medical attention. Understanding the causes, recognizing the symptoms, and knowing the treatments can significantly improve outcomes for mothers experiencing PPH. If you’re concerned about your risk of postpartum haemorrhage, you can speak to Dr Shivanjali Nayak, the best female gynaecologist in Newtown, for advice and information about your situation.