Postpartum Hemorrhage

Types of PPH

• Primary PPH: This is the most common type, occurring within the first 24 hours after delivery.
• Secondary PPH: This occurs between 24 hours to 12 weeks postpartum.

Causes

Several factors can contribute to PPH, including:

• Uterine atony: This is the most common cause, where the uterus fails to contract and clamp down on blood vessels after childbirth.
• Uterine trauma: Lacerations or tears in the uterus during delivery can cause significant bleeding.
• Retained placental tissue: If pieces of the placenta remain in the uterus, they can prevent proper clotting and lead to bleeding.
• Atony (loss of muscle tone) or rupture in other areas: This can involve the cervix, vagina, or other genital tissues.
• Preexisting medical conditions: Conditions like fibroids or clotting disorders can increase the risk of PPH.

Signs and Symptoms

• Heavy vaginal bleeding that soaks through pads quickly
• Feeling faint, dizzy, or lightheaded
• Rapid heart rate
• Rapid breathing
• Pale skin
• Feeling cold and clammy
• Shortness of breath
• Decreased urine output

Risk Factors

• Previous history of PPH
• Multiple pregnancies
• Delivering a large baby (macrosomia)
• Uterine fibroids
• Preeclampsia or eclampsia
• Placenta previa (placenta implanted low in the uterus)
• Abruptio placenta (placenta separates from the uterine wall prematurely)
• Premature birth
• Assisted delivery (vacuum extraction or forceps)

Diagnosis

Doctors diagnose PPH based on the amount of blood loss and a woman’s symptoms. They may also perform a physical exam to check for uterine tenderness or retained placental tissue.

Treatment 

Prompt treatment is crucial to prevent complications from PPH. Treatment options may include:

• Medications to stimulate uterine contractions (uterine tonics)
• Manual massage of the uterus to promote clotting
• Blood transfusions to replace lost blood
• Packing the uterus with gauze or balloons to apply pressure
• Surgery to remove retained placental tissue or repair lacerations
• In severe cases, hysterectomy (removal of the uterus) may be necessary as a last resort.
• Prohylactic temporary balloon occlusion of internal iliac arteries can be performed to prevent and minimize post partum blood loss (Click here to read more on Prophylactic balloon occlusion for placental abnormalities).

Prevention

Several measures can help reduce the risk of PPH, including:

• Proper prenatal care
• Active management of the third stage of labor (after delivery of the baby) with medications to promote uterine contractions
• Careful monitoring of blood loss after delivery
• Administering medications to prevent blood clots in high-risk women