PPH is severe bleeding that occurs after giving birth. It is a serious and potentially fatal condition. PPH typically occurs within 24 hours of childbirth but can occur up to 12 weeks later. When bleeding is detected early and treated promptly, it improves outcomes.
Postpartum hemorrhage occurs when the total blood loss after delivery exceeds 32 fluid ounces, whether the delivery was vaginal or a Cesarean section, or C-section, or when bleeding is severe enough to cause excessive blood loss or a significant change in heart rate or blood pressure.
What types of postpartum hemorrhage exist?
PPH is classified into two types. Primary postpartum hemorrhage happens within the first 24 hours of giving birth. Secondary or late postpartum hemorrhage occurs between 24 and 12 weeks after delivery.
What causes postpartum hemorrhage?
There are several causes of postpartum hemorrhage.
During pregnancy, your placenta attaches to the uterine wall and provides food and oxygen to your baby. Your uterus continues to contract after your baby is born to deliver the placenta. This is referred to as the third stage of labor. Contractions also help to compress the blood vessels that connect the placenta to the uterine wall. These contractions are not always strong enough to stop the bleeding (called uterine atony). This accounts for up to 80% of postpartum hemorrhages.
Postpartum hemorrhage can also occur if the placenta remains attached to the uterine wall or your reproductive organs are damaged during delivery. If you have a blood clotting (coagulation) disorder or certain health conditions, you are more likely to develop PPH.
Who is affected?
Anyone can experience postpartum hemorrhage after giving birth. PPH has many risk factors, but approximately 40% of hemorrhages occur in women with no risk factors. The majority of postpartum hemorrhage occurs shortly after the placenta is delivered. PPH may be more common following a C-section.
Is postpartum hemorrhage common?
Postpartum hemorrhage affects 1% to 10% of pregnancies.
What is the severity of postpartum hemorrhage?
Postpartum hemorrhage is a potentially fatal medical condition. You can lose much blood quickly if you have PPH. It causes a significant drop in blood pressure, restricting blood flow to the brain and other organs. This is known as shock, and it can be fatal. Postpartum hemorrhage is a medical emergency that must be treated immediately.
Causes and Symptoms
What are the top four causes of postpartum hemorrhage?
The four Ts are the causes of postpartum hemorrhage (tone, trauma, tissue, and thrombin).
The following are the most common causes of PPH:
Uterine atony (or uterine tone) refers to a soft and weak uterus following delivery. This occurs when your uterine muscles do not contract sufficiently to close the placental blood vessels. This causes a steady loss of blood following delivery.
Uterine trauma: Bleeding occurs when your vagina, cervix, uterus, or perineum (the area between your genitals and anus) is damaged. Using forceps or vacuum extraction during labor can increase your risk of uterine trauma. A hematoma (blood collection) can form in a hidden area and cause bleeding hours or days after delivery.
Retained placental tissue occurs when the entire placenta remains attached to the uterine wall. It is usually caused by placental conditions that impair your uterus’s ability to contract after delivery.
Blood clotting disorder (thrombin): If you have a coagulation disorder or a pregnancy condition like eclampsia, it can impair your body’s ability to clot. Even a minor bleed can become uncontrollable as a result of this.
How do I know if I am hemorrhaging after giving birth?
Persistent, excessive bleeding after delivery is the most common symptom of postpartum hemorrhage.
Other symptoms of PPH include:
Blood pressure drop symptoms include dizziness, blurred vision, and feeling faint.
Heart rate has increased.
Red blood cell count is low.
Skin that is pale or clammy.
Vomiting or nausea
Increased abdominal or pelvic pain.
Tell your healthcare providers how you are feeling after giving birth. PPH can cause symptoms after you have left the hospital in some cases. Contact your healthcare provider immediately if you experience any of the symptoms listed above in the days or weeks following childbirth.
Tests and Diagnosis
What are the symptoms of postpartum hemorrhage?
Healthcare providers diagnose postpartum hemorrhage through visual and physical examinations, lab tests, and a thorough review of your medical history.
Based on the amount of blood you have lost, they may be able to detect postpartum hemorrhage. One standard method for estimating blood loss is to measure collected blood volume and weigh the blood-soaked pads or sponges from delivery.
Other methods for detecting PPH include continuously monitoring your pulse rate and blood pressure.
Blood tests to determine the concentration of red blood cells (hematocrit) and clotting factors.
An ultrasound will be performed to obtain a detailed image of your uterus and other organs.
Treatment and Management
What is the treatment for postpartum hemorrhage?
In most cases, healthcare providers treat PPH as an emergency. Treating postpartum hemorrhage aims to stop the source of the bleeding as soon as possible and to replace blood volume.
Among the treatments employed are:
- Massage your uterus to help the muscles contract.
- Medication that causes contractions.
- Removing uterine retained placental tissue
- Vaginal, cervical, and uterine tears or lacerations are repaired.
- Using sterile gauze to pack your uterus or tie off the blood vessels.
- Putting pressure on your uterine walls with a catheter or balloon.
- Embolism of the uterine artery.
- Transfusion of blood.
In rare cases, or when all other options have been exhausted, your healthcare provider may perform a laparotomy or hysterectomy. A laparotomy is a surgical procedure in which your surgeon makes an incision in your abdomen to locate the source of the bleeding.
What medications are used to treat postpartum hemorrhage?
If uterine atony is the cause of the bleeding, you may be given medications to help induce contractions. Oxytocin, methylergonovine, and prostaglandins such as carboprost or misoprostol are the most commonly used drugs.
What are the risks associated with postpartum hemorrhage?
Excessive blood loss can result in several complications, including an increased heart rate, rapid breathing, and decreased blood flow. These symptoms can cause a reduction in blood flow to your liver, brain, heart, or kidneys, resulting in shock. Sheehan’s syndrome (a pituitary gland condition) is sometimes seen after postpartum hemorrhage.
Who is more prone to postpartum hemorrhage?
PPH is most common in women with placental issues such as placenta accrete, placenta previa, placental abruption, or retained placenta.
An overextended uterus also increases PPH. This occurs when your uterus is stretched as a result of the following:
Pregnancies in multiples.
Having twins, triplets, or more children.
Giving birth to a large child (9 pounds or more).
There is too much amniotic fluid.
During labor and delivery, the following factors can increase your risk of hemorrhage:
To induce labor, you were given oxytocin (Pitocin®).
You were put under general anesthesia.
Tocolytics were administered to you in order to halt labor.
Long hours of work.
During labor, an infection occurs.
During vaginal delivery, tears (perineal lacerations) occur.
PPH was present in previous deliveries.
Other health issues that may increase your risk of postpartum hemorrhage include:
High blood pressure, also known as preeclampsia.
Disorders of blood clotting or other blood-related conditions
Pregnancy-related intrahepatic cholestasis (ICP).
Maternal age has advanced.
A track record of at least five previous deliveries.
How can I avoid bleeding during childbirth?
The best way for healthcare providers to prevent postpartum hemorrhage is to identify high-risk patients before delivery. This is contingent on you disclosing your entire medical history and symptoms to your healthcare provider. It is also important to give medications like oxytocin to your uterus at the delivery time to help it contract. Ensuring adequate iron intake and red blood cell levels during pregnancy can help reduce the severity of postpartum hemorrhage.
Prognosis / Outlook
What causes postpartum hemorrhage to be fatal?
Without prompt treatment, postpartum hemorrhage can result in death. Shock can result from excessive blood loss. Shock occurs when your organs do not receive adequate blood flow.
Having to Deal With
What is the best way to recover from postpartum hemorrhage?
Everyone’s path to recovery is unique. The severity of the blood loss and how your healthcare provider treats it determine how quickly you recover from a postpartum hemorrhage. Take care of yourself in the days after delivery by eating well, drinking plenty of water, and resting as much as possible. Your doctor may recommend an iron supplement to help with anemia.
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