When a woman has severe bleeding after giving birth, it is known as postpartum hemorrhage (also known as PPH). It’s a dangerous yet uncommon ailment. It normally occurs within one day of giving birth, however, it can occur up to 12 weeks later. PPH affects 1 to 5 out of every 100 women who give birth (1 to 5%).
After giving delivery, it’s usual to lose some blood. During vaginal birth, women lose about half a quart (500 milliliters), while following a cesarean birth, they lose about a quart (1,000 milliliters) (also called c-sections).
A c-section is a procedure in which your baby is delivered through a cut in your belly and uterus made by your obstetrician (womb).
PPH causes you to lose a lot more blood, which is why it’s such a serious condition. PPH can result in a significant reduction in blood pressure.
This can result in shock and death if not addressed promptly. When your body organs don’t get adequate blood flow, it’s called shock.
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Table of Contents
What are the types of postpartum hemorrhage?
PPH is divided into two types. Within the first 24 hours following delivery, there is a primary postpartum hemorrhage. Secondary or late postpartum hemorrhage can happen anywhere between 24 hours and 12 weeks after giving birth.
What Causes PPH?
During pregnancy, your placenta attaches to the wall of your uterus and gives nourishment and oxygen to your baby. Your uterus continues to contract after your baby is born in order to deliver the placenta. The third stage of labor is referred to as.
Contractions also aid in the compression of the blood veins that connect the placenta to the uterine wall. These contractions aren’t always powerful enough to halt the bleeding (called uterine atony). Up to 80% of all postpartum hemorrhages are caused by this.
If pieces of the placenta remain attached to your uterine wall or if your reproductive organs are damaged after delivery, postpartum bleeding can occur. If you have a blood clotting (coagulation) disease or certain health conditions, you’re more likely to develop PPH.
To explain this better, the four Ts are the causes of postpartum hemorrhage (tone, trauma, tissue, and thrombin).
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The following are the most common causes of PPH:
Uterine Atony:
Uterine atony (or uterine tone) is a soft and weak uterus that occurs after delivery. When your uterine muscles aren’t strong enough to close the placental blood arteries, this happens. After delivery, this causes a constant loss of blood.
Uterine Trauma:
Damage to the vagina, cervix, uterus, or perineum (the area between your genitals and anus) produces uterine trauma. Using forceps or vacuum extraction after delivery can put your uterus at risk of uterine trauma. A hematoma (blood accumulation) in a hidden region might form and cause bleeding hours or days after delivery.
Retained Placenta Tissue:
When the complete placenta does not split from the uterine wall, it is called retained placental tissue. It’s frequently caused by placental issues that prevent your uterus from contracting after delivery.
Blood clotting disorder (thrombin):
If you have a coagulation problem or a pregnant condition like eclampsia, your body’s ability to clot can be hampered. Even a small hemorrhage can become unmanageable as a result of this.
Is PPH more common in some women than others?
Yes. Risk factors are things that make you more likely than others to develop PPH. A risk factor does not guarantee that you will develop PPH, but it certainly raises your chances. PPH occurs without warning most of the time. However, talk to your doctor about what you may do to lower your risk of developing PPH.
If you’ve had PPH before, you’re more likely to get it again than other women. This is referred to as having a PPH history. PPH is also more common in Asian and Hispanic women than in other groups.
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Diagnoses
Visual and physical examinations, lab testing, and a comprehensive assessment of your medical history are used to diagnose postpartum hemorrhage.
Based on the volume of blood you’ve lost, they may be able to detect postpartum hemorrhage. One popular method for estimating blood loss is to measure the volume of collected blood and weigh the blood-soaked pads or sponges from delivery.
PPH can also be diagnosed using the following methods:
- To discover abnormalities, your pulse rate and blood pressure should be monitored on a regular basis.
- Hematocrit (the percentage of red blood cells in the body) and clotting factors are measured in blood tests.
- To get a detailed image of your uterus and other organs, you’ll need an ultrasound.
Treatment
In the majority of cases, healthcare providers treat PPH as an emergency. The goals of treating postpartum hemorrhage are to stop the bleeding as soon as possible and replace blood volume.
- Clotting factors tests are often known as factor assays.
- Hematocrit -This is a blood test that determines the percentage of your blood that is made up of red blood cells (also known as whole blood). A low hematocrit can be caused by bleeding.
- The amount of blood lost is calculated. Your provider may weigh or count the number of pads and sponges used to soak up the blood to determine how much blood you’ve lost.
- Examining the pelvis. Your doctor examines your vaginal, uterine, and cervix.
Examination of the body. Your blood pressure and pulse are checked by your doctor. - Ultrasound can be used by your doctor to check for abnormalities in the placenta or the uterus. Ultrasound is a test that creates an image of your baby within the womb or your pelvic organs using sound waves and a computer screen.
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The type of treatment you receive is determined by the cause of your bleeding. It could include receiving fluids, medication (such as Pitocin), or a blood transfusion (having new blood put into your body).
These therapies are given through a needle inserted into your vein (commonly known as intravenous or IV) or directly into the uterus.
- Surgery, such as a hysterectomy or laparotomy. A hysterectomy is when your uterus is removed by your doctor. A hysterectomy is usually only necessary if other therapies have failed. A laparotomy is a procedure in which your doctor opens your tummy to check for and control bleeding.
- Hand massage of the uterus Your healthcare professional can massage your uterus to help it contract, reduce bleeding, and pass blood clots. Your doctor may also prescribe oxytocin, a hormone that causes the uterus to contract and reduces bleeding.
- Wearing an oxygen mask to get oxygen
- Supplementing with extra iron and a prenatal vitamin may also be beneficial. Depending on how much blood was lost, your doctor may advise you to do so.
