Postpartum hemorrhage (PPH) is bleeding that is greater than 500cc after a vaginal delivery or 1000cc after a caesarean section. It typically arises within the first 24 hours after birth (primary PPH) but can also occur later (secondary PPH).
It is the leading cause of maternal morbidity and mortality worldwide and in Kenya.
Diagnosis of post-partum hemorrhage can also be made if the following is present:
- Pad or cloth soaking in 5min
- Constant trickling of blood
- Delivered outside the hospital and still bleeding
- Accompanying hemodynamic instability (abnormal heart rate, unstable blood pressure)
Types of post-partum hemorrhage
- Primary post-partum hemorrhage: Excessive vaginal bleeding within 24hours of delivery. Most primary post-partum hemorrhage occurs within four hours of delivery.
- Secondary post-partum hemorrhage: Excessive vaginal bleeding that occurs 24hours after childbirth until 6weeks after child birth. Commonly caused by infection
Causes
- Uterine atony: The uterus fails to contract effectively after delivery, leading to heavy bleeding.
- Retained placenta: Fragments of the placenta remain in the uterus after delivery.
- Trauma: Tears in the cervix, vagina, or perineum, or uterine rupture.
- Coagulation disorders: Conditions that affect the blood’s ability to clot.
Risk Factors
- Prolonged labor
- Multiple gestation (twins, triplets)
- High parity (multiple previous births)
- Induced labor or augmentation with oxytocin
- Operative delivery (forceps or vacuum-assisted)
- Placenta Previa or accrete
- Previous history of PPH
Symptoms
- Uncontrolled bleeding
- Decreased blood pressure
- Increased heart rate
- Signs of shock (pale skin, weakness, confusion)
Management
- Prevention: Active management of the third stage of labor (e.g., administering uterotonic drugs like oxytocin).
- Medical treatment: Uterotonic drugs to help the uterus contract, such as oxytocin, misoprostol, or ergometrine.
- Mechanical treatment: Uterine massage or balloon tamponade.
- Surgical treatment: Repair of lacerations, removal of retained placenta, or in severe cases, a hysterectomy.
- Blood transfusion: To replace lost blood and stabilize the patient.
Complications
- Severe anemia
- Hypovolemic shock
- Sheehan’s syndrome (pituitary gland necrosis)
- Death (if not managed promptly)
Incase you experience the above signs and symptoms and you have already left the hospital, do not hesitate to reach out to us on https://hellodaktari.co.ke and book an appointment with us.