POST PARTUM HEMORRHAGE
Dr. Kamela Khalid
Mosque road, Bengaluru Jan 9, 2017
POST PARTUM HEMORRHAGE
- Postpartum hemorrhage is excessive bleeding following the birth of a baby. About 1% to 5% of women have postpartum hemorrhage and it is more likely with a cesarean birth. Hemorrhage most commonly occurs after the placenta is delivered.
- Postpartum hemorrhage (also called PPH) is when a woman has heavy bleeding after giving birth. It's a serious but rare condition. It usually happens within 1 day of giving birth, but it can happen up to 12 weeks after having a baby. About 1 to 5 in 100 women who have a baby (1 to 5 percent) have PPH.
- Postpartum bleeding or postpartum hemorrhage (PPH) is often defined as the loss of more than 500 ml or 1,000 ml of blood within the first 24 hours following childbirth. Some have added the requirement that there also be signs or symptoms of low blood volume for the condition to exist.
- Conditions that may increase the risk for postpartum hemorrhage include the following:
- Placental abruption. The early detachment of the placenta from the uterus.
- Placenta prevails. ...
- Over distended uterus. ...
- Multiple pregnancies. ...
- Gestational hypertension or preeclampsia. ...
- Having many previous births.
- Prolonged labor.
Once you deliver the placenta after the birth, your womb (uterus) should contract strongly to shut off the blood vessels where it was attached. The most common reason for heavy bleeding soon after the birth is the womb not contracting down properly. The medical term for this is uterine agony.
Your womb contracts naturally in the third stage of labour making the placenta peel away and then pushing it out. A routine option is to have an actively managed third stage, which involves an injection to help your womb to contract down and then your midwife helps to deliver the placenta.
Having the injection reduces the risk of heavy bleeding soon after the birth.
Losing 500ml or more of blood in the first 24 hours after birth is called a primary postpartum hemorrhage (PPH). It's relatively common for women to have a minor PPH, losing between 500ml and 1000ml of blood after birth, and most are able to cope well physically with a blood loss of this amount.
A major PPH would be blood loss of over 1000ml. Major PPH after a vaginal birth is rarer and more serious. If your midwife suspects a very heavy bleed after the birth, you're likely to find yourself suddenly surrounded by doctors and midwives, all there to give you emergency treatment.
Though it's not always the case, primary PPH is more likely to happen because of uterine atony if you:
have bleeding before giving birth (ante partum hemorrhage)
had primary PPH before (this applies to 15 per cent to 25 per cent of cases)
have a low-lying placenta
are aged 40 or over
are of Asian or Black African ethnicity
became pregnant using assisted conception
If you have a heavy bleed after the birth, you may feel the blood trickling out of your vagina, or it may build up inside your womb or vagina and gush out when you move or stand up. You may not even be aware of PPH until other signs and symptoms appear, such as:
a drop in your blood pressure
a rise in your pulse rate
feeling faint and dizzy
Your midwife will regularly check the top of your womb (fundus) after you've given birth, to make sure it stays firm and contracted. If it’s soft, she will encourage a contraction by massaging your tummy. She'll also monitor your vaginal blood loss to make sure it isn’t too heavy.
Your midwife will treat you with drugs via a drip, injection, or a suppository to help your womb to contract down. If you have a tear, your midwife or doctor will carefully stitch it.
Your doctor may also give you iron tablets to help your blood levels return to normal. If you lose a lot of blood, you may need a blood transfusion, but this is rare.
There are several other reasons why heavy bleeding may occur after the birth, which are less common than uterine atony. These include:
Retained placenta or membranes left behind in your womb after the birth, which stop the blood vessels sealing off properly.
Injury to you during the birth, as a result of a planned or emergency caesarean birth. Greater blood loss is expected on average during a caesarean birth when compared with vaginal birth, particularly in an emergency caesarean.
Losing 500ml or more of blood between 24 hours and 12 weeks after having your baby is called secondary PPH. It's most common in the second week. However secondary PPH only happens in under one per cent of births.
If you’re at home and you pass a clot larger than a 50p piece or have a sudden gush of blood, then contact your midwife or maternity unit as soon as possible. If you can keep hold of the clot you have passed then this will help the midwife assess the situation when she examines you.
You're more likely to have secondary PPH if you've had a primary PPH or a retained placenta.
The bleeding may be due to small pieces of the placenta or membrane being retained in the womb, or an infection. If this is the case, you may need to have antibiotics to clear the infection. Or your doctor may need to perform a minor operation to remove tissue fragments from your womb.