Women who are affected by postpartum hemorrhage, also known as PPH, experience uncontrollable bleeding after baby delivery. This usually occurs within a day of giving birth, but it can sometimes happen up to 12 weeks later.
Blood loss during childbirth is common, but postpartum hemorrhage is far more serious. Postpartum hemorrhage can result in considerable blood loss, which can lower the mother’s blood pressure and limit the blood supply to her internal organs, both of which are fatal.
How does PPH Happen?
The placenta is an organ that develops in the uterus during pregnancy and provides the fetus with oxygen, food, and nutrition. Additionally, it eliminates the fetus discharged waste. The fetal umbilical cord emerges from the placenta as it is attached to the uterine wall.
The uterus usually contracts after childbirth to force the placenta out. The blood veins close to where the placenta is attached are under pressure as a result. The vessels bleed profusely during labor if the contractions aren’t strong enough. Bleeding can also occur if the placenta’s components aren’t expelled.
If the placenta isn’t delivered within 30 minutes after childbirth, it’s known as a retained placenta. Placental remaining which are attached to the uterine wall can cause severe infection or life-threatening blood loss.
Signs of placental problems include:
- Abdominal pain
- Back pain
- Uterine contractions
What are the Symptoms of Postpartum Hemorrhage (PPH)?
Every woman is unique and may experience postpartum hemorrhage differently. The key symptoms of postpartum hemorrhage include:
- Uncontrolled bleeding
- Decreased blood pressure
- Increased heart rate
- Decreased red blood cell count
- Swelling and pain in the vaginal area
What are the Causes of PPH?
There are few conditions that subject few women to more risk for postpartum hemorrhage than others. The factors which make them more prone to PPH are:
- Abruption of the placenta, which involves the unexpected prior detachment of the placenta from the uterus
- Placenta Previa, a condition when the placenta covers the cervical opening.
- Enlarged uterus due to the presence of a large quantity of amniotic fluid or baby’s size being huge.
- Multigravida women
- Pre-eclampsia, a complication that is caused due to high blood pressure during pregnancy
- Duration of labor being longer
- Unhealthy weight and unhygienic
- Intake of medications to either induce labor or stop contraction pain
- The use of vacuum-assisted delivery or forceps
- Usage of general anesthesia
What are the after-effects of PPH?
Postpartum hemorrhage may also lead to:
- Cervical or vaginal tissue tear
- Tearing of uterine blood vessel
- Bleeding into a tissue area that is not readily visible (usually the vulva or vagina)
- Complications related to the blood clot
- Disorders related to Placenta
How is PPH Diagnosed?
Your doctor can help you in diagnosing the condition of postpartum hemorrhage. After reviewing your health history, a variety of tests can be done to ensure the risk factor. Some are mentioned below:
- A major analysis of the amount of blood loss
- Measuring blood pressure and pulse
- Measuring red blood cell count
- Looking for potential blood clots
How is PPH Treated?
Treatment options for PPH conditions are widespread, but the right choice involves the evaluation of a few factors like:
- Overall patient’s pregnancy and health history
- Based on the complexity of postpartum hemorrhage condition
- Individual’s response to various medications and treatments.
- Your personal preference
The goal of treatment is to prevent bleeding as quickly as possible. Treatment for PPH may include:
- Medication
- Massaging the uterus to start contractions
- Removing the residual placenta pieces if present in the uterus
- Detailed inspection of the pelvis and uterus.
- Insertion of a Foley catheter or a Bakri balloon to cease the flow of blood in the uterus
- Concealing the uterus with any sterile material or sponge.
- To secure bleeding blood vessels tightly.
- Performing procedures to spot where the abdomen is cut and to know the initial point of hemorrhage
- Ultimate choice involves the surgical removal of the uterus.
Restoration of the fluids and blood being lost is important in the treatment of postpartum hemorrhage. Intravenous (IV) fluids, as well as blood and blood products, must be replenished rapidly to prevent shock. The mother may also be supplemented with the external intake of oxygen. Postpartum hemorrhage can be quite serious. Catering a rapid detection and treatment for the cause of bleeding can effectively help in the holistic recovery of the mothers.
Studies Regarding Post-Partum Hemorrhage Cases
Blood loss of more than 500mL after vaginal birth and 1,000 mL after a cesarean delivery is generally referred to as postpartum hemorrhage (PPH). However, there are many different definitions, and the diagnosis of PPH is based on erroneous calculations of blood loss. Additionally, typical blood loss at birth frequently surpasses 500 or 1000 mL, and hemorrhage or blood loss shock symptoms may go undetected due to an increase in plasma volume during pregnancy. The urgent nature of the disorder complicates the proposed alternative metrics for defining and diagnosing PPH, which include changes in hematocrit, transfusion demand, the velocity of blood loss, and changes in vital signs. PPH is frequently categorized as primary/immediate/early, occurring within 24 hours of birth, or secondary/delayed/late, happening more than 24 hours later.
The estimated global prevalence of PPH ranges from 6 to 11 percent, with a significant geographical variation. Depending on the measurement method, the prevalence varies. When determined using the criterion of evaluating blood loss, 10.6% of PPH cases are evaluated, compared to 7.2 percent when determined using subjective methods, and 5.4 percent when assessment is not determined. Numerous studies have documented an increase in PPH in high-resource countries like the US, Canada, Australia, Ireland, and Norway since the 1990s. A study found that between 1994 and 2006, the prevalence of PPH in the United States rose by 26%. (2.3 percent vs. 2.9 percent, respectively, p 0.001). Another U.S. study found that the prevalence of severe PPH increased from 1.9 percent in 1999 to 4.2 percent in 2008 (p 0.0001).
Adverse Outcomes Associated with Post-Partum Hemorrhage
PPH is a significant cause of illness and mortality in mothers worldwide and accounts for nearly one-fourth of all maternal pregnancy-related fatalities. Numerous studies have shown that early detection and subsequent simple treatment can prevent many PPH-related deaths. PPH has a lot of harmful outcomes that can have large morbidity, including organ failure, shock, edema, compartment syndrome, transfusion issues, thrombosis, acute respiratory distress syndrome, sepsis, anemia, intensive care, and prolonged hospital admissions.
The most common cause of PPH is uterine atony, which affects uterine contractions after birth in around 80% of cases. Atony may be caused by uterine enlargement, infection, placental abnormalities, or hypertrophy of the bladder. Even though there are no established risk factors for the majority of women who develop PPH, clinical signs of uterine atony such as multiple gestations, polyhydramnios, high parity, and delayed labor may cause one to be more suspicious. Other causes of PPH include uterine rupture or inversion, retained placenta, blood clots, hereditary or acquired clotting problems, and laceration.
