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. Read on to know more about postpartum hemorrhage.
In some rare cases, some women tend to have an excessive blood flow during birthing. This leads to bleeding and requires immediate medical intervention. This is a severe condition that could be fatal to the mother’s life. Read on to understand the causes, symptoms, and treatment that will be provided for postpartum hemorrhage.
In This Article
- What Is Postpartum Hemorrhage (PPH)?
- Symptoms Of Postpartum Hemorrhage
- What Are The Risk Factors Of PPH?
- What Are The Causes Of Postpartum Hemorrhage?
- How Is Postpartum Hemorrhage Diagnosed?
- How Is Postpartum Hemorrhage Treated?
- Ways To Prevent Postpartum Hemorrhage
- What Happens After A Postpartum Hemorrhage?
- Can You Experience Postpartum Hemorrhage If You Had It Before?
What Is Postpartum Hemorrhage (PPH)?
It is normal to lose blood following the delivery. And compared to vaginal birth, after a c section, women lose more blood, which is also quite reasonable. Postpartum hemorrhage is an excessive loss of blood during childbirth. In the case of vaginal birth, more than 500 ml of blood loss, and in the case of C-sections, 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.
Symptoms Of Postpartum Hemorrhage
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 Hemorrhage?
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;
1. 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 stretched 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 remains 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 Hemorrhage Diagnosed?
There are several ways to diagnose PPH, like:
- 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 Hemorrhage 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 help to find and correct the cause of excessive bleeding. Even the team may perform a hysterectomy as a last resort.
Ways To Prevent Postpartum Hemorrhage
After delivery, certain precautions you must take some precautionary measures 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, refers to pulling the umbilical cord while applying an opposing pressure. This will facilitate placental expulsion.
- Let only an expert perform this. 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 vaginal delivery.
- Consuming iron supplements to constrict blood flow in case of Anaemia during pregnancy.
- In case of subsequent pregnancy where the previous was a C-section, the doctor will check the position of the placenta. Placenta expulsion can be difficult if attaches to the scar from the previous delivery.
- In the case of disorders like blood clotting, treatment involves the replacement of suitable blood components, administration of medicines to promote blood clots, support for intravascular volume, etc.
What Happens After A Postpartum Hemorrhage?
After the treatment for PPH and once the bleeding is under control, the medical team will observe you closely. They perform blood tests to check blood clots. The team also monitor your BP, and output of urine. They also check the signs for internal bleeding. If the doctor detects no further risk in your condition, they will shift you to your personal ward.
Can You Experience Postpartum Hemorrhage 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. There are appropriate blood tests 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!
