PostPartum Hemorrhage (PPH): Causes, Symptoms and Treatment

Postpartum bleeding or postpartum hemorrhage (PPH) is defined as the loss of more than 500 ml of blood after spontaneous vertex delivery or 1,000 ml of blood after cesarean section within the first 24 hours following childbirth.

In mothers who have low hemoglobin levels, any minimal loss of blood per vaginally can cause significant hemodynamic instability.

Some have added the requirement that there also be signs or symptoms of low blood volume for the condition to exist.

Signs and Symptoms

Signs and symptoms may initially include:

• Vaginal bleeding and signs of shock
• An increased heart rate,
• Feeling faint upon standing, and
• An increased breath rate.
• As more blood is lost, the woman may feel cold,
• Blood pressure may drop, and she may become restless or unconscious.

The condition can occur up to six weeks following delivery.

Causes of Postpartum hemorrhage

There are four Ts for PPH

1. Tone
2. Trauma
3. Thrombosis
4. Tissues

The most common cause is the poor contraction of the uterus following childbirth known as uterine atony.
Not all of the placenta being delivered, a tear of the uterus or poor blood clotting are other possible causes.

It occurs more commonly in those who: already have a low amount of red blood, are Asian, with bigger or more than one baby, are obese or are older than 40 years of age.

It also occurs more commonly following cesarean sections, those in whom medications are used to start labor, those requiring the use of a vacuum or forceps, and those who have an episiotomy.

Management of Postpartum hemorrhage

Prevention involves decreasing known risk factors including procedures associated with the condition, if possible, and giving the medication oxytocin to stimulate the uterus to contract shortly after the baby is born

Misoprostol may be used instead of oxytocin in resource-poor settings.

Treatment may include:

Intravenous fluids,

Blood transfusions and ergotamine to cause further uterine contraction.

Efforts to compress the uterus using the hands may be effective if other treatments do not work.
Aortic compression can also relieve bleeding.