Postpartum haemorrhage (PPH), or postpartum bleeding, is a complication of childbirth that, if not managed correctly, can lead to various complications including maternal death. Fortunately, with professional health workers carrying out most child deliveries in Anguilla, and with the use of new and improved medications, many of the complications associated with PPH can be prevented or treated successfully.
What is postpartum haemorrhage?
Primary postpartum haemorrhage (PPH) is defined as loss of blood estimated to be greater than 500 ml, from the genital tract, within 24 hours of delivery.
Secondary PPH is defined as abnormal bleeding from the genital tract, from 24 hours after delivery until six weeks postpartum.
About 1 to 5 percent of women have postpartum haemorrhage. Postpartum haemorrhage most commonly occurs after the placenta(afterbirth) is delivered, but it can also happen later.
What causes postpartum hemorrhage?
Once a baby is delivered there is much excitement and the newborn becomes the centre of attention, but the healthcare professionals must also pay close attention to the new mother. Following delivery, the uterus (womb) normally contracts and pushes out the placenta. After the placenta is delivered, these contractions help put pressure on the bleeding vessels in the area where the placenta was attached. If the uterus does not contract strongly enough, these blood vessels bleed freely. This is the most common cause of postpartum hemorrhage. In some cases, if small portions of the placenta are retained this can also result in excessive bleeding. Postpartum hemorrhage may also be caused by:
• Tear in the cervix or tissues of the vagina
• Tear in a blood vessel in the uterus
• Blood clotting disorders
• Placenta problems
Who gets PPH?
Some women are at greater risk for postpartum haemorrhage than others. Conditions that may increase the risk include:
• Placenta praevia (The placenta covers or is near the opening of the cervix.)
• Overdistended uterus. The uterus is larger than normal because of too much amniotic fluid or a large baby.
• Multiple pregnancy
• High blood pressure disorders of pregnancy
• Having many previous births
• Prolonged labour
• Infection
• Obesity
• Use of forceps or vacuum-assisted delivery
Management of postpartum haemorrhage
The aim of treatment of postpartum hemorrhage is to find and stop the cause of the bleeding as soon as possible. Treatment may include:
• Medicine or uterine massage to stimulate uterine contractions
• Removing pieces of the placenta that remain in the uterus
• Examination of the uterus and other pelvic tissues, the vagina, and the vulva, to look for areas that may need repair
• Various techniques are used to control bleeding. Sometimes surgery might be needed. Hysterectomy – removal of the uterus is used as a last resort to control the bleeding.
Replacing loss blood and fluids is important in treating postpartum hemorrhage. You may quickly be given IV (intravenous) fluids, blood, and blood products to prevent shock.
Postpartum hemorrhage can be quite serious. In most cases when your obstetrician quickly finds and treats the cause of bleeding, the patient often will be able to recover fully.
When should I call my healthcare provider?
Most cases of postpartum hemorrhage occur at delivery or soon after. In some cases, heavy bleeding might occur after the new mother was discharged from the hospital. If this happens, call your healthcare provider right away or go straight to the accident and emergency department immediately.
Prevention
It is always better to prevent postpartum haemorrhage. Regular prenatal care by a qualified healthcare professional might be able to identify some women who are at risk for developing postpartum haemorrhage and then manage appropriately. All pregnant women are encouraged to get regular prenatal care. All facilities carrying out deliveries should also have the resources to deal with postpartum haemorrahage.
Conclusion
Postpartum haemorrhage in the past was a common cause of maternal death. With increased training of staff, improved facilities, and more pregnant women having regular prenatal care, the management of postpartum haemorrhage has improved in several countries, including Anguilla. We still must be aware that postpartum haemorrhage if not managed professionally and correctly can result in several complications including death.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB BS DGO MRCOG, is an Obstetrician/Gynaecologist and Family Doctor who has over thirty-five years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
