Postpartum haemorrhage

Specialty of Obstetrics & gynaecology

What is postpartum haemorrhage?
Postpartum haemorrhage is the heavy bleeding that occurs following the birth of a baby and is considered an emergency complication of childbirth. It is estimated that 1 to 5 percent of women may experience excessive bleeding, which is more common following a caesarean birth.

A minor postpartum haemorrhage is defined as a loss of 500ml to 1000ml of blood, whilst a major postpartum haemorrhage is defined as over one litre of blood, and if there is a blood loss of over two litres it is severe. It can lead to anaemia and is a leading cause of maternal death. Postpartum haemorrhage usually happens just after birth but it can occur up to 12 weeks after giving birth.

What causes postpartum haemorrhage?
Normally once a baby is delivered, the uterus continues to contract and tighten and expels the placenta. Once the placenta is delivered, the contractions help compress the bleeding vessels where the placenta was attached. If the uterus does not tighten strongly enough, the blood vessels bleed freely, which create the haemorrhage. Bleeding is also likely if small pieces of the placenta remain attached. Some women are more at risk than others.

What are the symptoms?
The most common symptoms include:

• Uncontrolled bleeding
• Drop in blood pressure
• Increased heart rate
• Decrease in red blood cell count
• Swelling and pain in the tissues inside the vaginal and perennial area, if the bleeding is due to a hematoma.

What conditions make some women more prone to the risk of postpartum haemorrhage?
The following conditions may increase the risk of postpartum haemorrhage:

• Placental abruption
• Placenta Previa – the placenta covers the cervical opening.
• Excessive enlargement of the uterus due to too much amniotic fluid or a large baby.
• Multiple pregnancies
• Preeclampsia
• Prolonged labour
• Infection
• Obesity
• Medications that were used to induce labour.
• General anaesthesia

How is it diagnosed?
The tests used to diagnose postpartum haemorrhage include:

• An estimation of how much blood loss has occurred – this is done by counting the number of saturated pads used to absorb blood.
• Heart pulse and blood pressure are measured.
• Red blood cell count is made.
• Examining of clots in the blood.

How is postpartum haemorrhage treated?
The treatment is to find and stop the cause of the excessive bleeding immediately. This may include:
• Medication
• Manual massage of the uterus, which stimulates contractions.
• Removing the remaining placental pieces in the uterus.
• Examining the uterus and pelvic tissues.
• A Foley catheter to compress the bleeding inside the uterus.
• Uterine compression sutures.
• Laparotomy surgery, to open the abdomen and find the cause of the blood loss.
• Hysterectomy, this surgical procedure to remove the uterus is a last resort.

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