PPH Definition

What is Postpartum Hemorrhage?

Severe bleeding after giving birth is known as postpartum hemorrhage (PPH). This condition is hazardous and terrible. PPH typically manifests within 24 hours of delivery. However, it can also appear up to 12 weeks after delivery. Early detection and prompt treatment of bleeding result in better outcomes.

Postpartum hemorrhage is defined as bleeding that is severe enough to result in symptoms of excessive blood loss or a significant change in heart rate or blood pressure following birth, regardless of whether it was a vaginal delivery, a Cesarean section, or a C-section.

What Kinds of Postpartum Hemorrhages are There?

PPH comes in two different forms. There is a primary postpartum hemorrhage throughout the first 24 hours following delivery. There may be secondary or late postpartum hemorrhage from 24 hours to 12 weeks after delivery.

Why does Postpartum Hemorrhage Happen?

There are several causes of postpartum bleeding.

• Your placenta connects to the uterine wall throughout pregnancy, feeding and oxygenating the developing fetus. Your uterus continues to contract after the baby's birth to deliver the placenta.
• We refer to this as the third stage of labor. The blood arteries where the placenta is linked to your uterine wall are likewise compressed by contractions.
• These contractions may not always be powerful enough to halt the bleeding (uterine atony).
• A postpartum hemorrhage may also occur if your reproductive organs are injured after birth or some of the placentae remain attached to your uterine wall.
• Your risk of developing PPH is enhanced if you suffer from a blood clotting (coagulation) disease or certain medical conditions.

Who is Affected by it?

Anyone can get postpartum hemorrhage after giving birth. Although there are multiple PPH risk factors, over 40% of hemorrhages in women happen without any known risk factors. The majority of postpartum bleeding happens immediately after placenta delivery. PPH might become more common following a C-section.

How Dangerous is Postpartum Bleeding?

Postpartum hemorrhage is a dangerous and sometimes lethal condition. You can lose a lot of blood quickly if you have PPH. Blood pressure suddenly drops, which may prevent your brain and other organs from receiving enough oxygen. This condition is known as shock, and it can be fatal. A postpartum hemorrhage is a medical emergency that requires immediate attention.

Significance and Causes

What are the Three Most Typical Reasons For Postpartum Bleeding?

PPH has the following most typical causes:

• Uterine atony: Postpartum uterine atony, or uterine tone, describes a fragile and frail uterus. This occurs when the uterine muscles are not sufficiently contracted to seal the placental blood vessels. After delivery, this causes a constant loss of blood.
• Uterine trauma: Bleeding results from injury to your vagina, cervix, uterus, or perineum (the region between your genitalia and anus). Your risk of uterine injuries can increase if you deliver the baby with forceps or vacuum extraction. A hematoma (gathering of blood) can occasionally develop in a hidden region and result in bleeding hours or days after delivery.
• Blood clotting disorder (thrombin):A coagulation problem or pregnancy disorder like eclampsia might affect your body's ability to clot blood. Due to this, even a small bleed may become unmanageable.

How can i Know if I'm Hemorrhaging After Giving Birth?

After birth, prolonged, heavy bleeding is the most typical sign of postpartum hemorrhage.

• Signs indicating a decline in blood pressure, such as lightheadedness, blurred vision, or feeling faint.
• A higher heart rate.
• Red blood cell count decline.
• Dull or cold skin.
• Vomiting or nauseous.
• A worsening of pelvic or abdominal pain.

Tell your medical professionals the truth about how you're feeling following delivery. Sometimes PPH symptoms don't appear till after you've left the hospital. If you experience any of the symptoms mentioned above in the days or weeks following giving delivery, call your healthcare professional right away.

Tests and Diagnosis

How is Postpartum Bleeding Identified?

1. Medical professionals diagnose postpartum hemorrhage through visual and physical examinations, blood tests, and a careful study of your medical history.
2. They might find postpartum hemorrhage based on how much blood they've lost.
3. One popular method to estimate blood loss is to weigh the blood-soaked sponges or pads from delivery and measure the volume of blood collected.

Additional ways to diagnose PPH include:

• Constantly checking your blood pressure and pulse rate for issues.
• Blood tests to assess clotting components and red blood cells.
• An ultrasound to see your uterus and other organs in great detail.

Control and Treatment

How do Doctors Handle Postpartum Bleeding?

Most of the time, medical professionals handle PPH as an emergency. The objectives of treating postpartum hemorrhage are replenishing blood volume and halting the source of the bleeding as quickly as feasible.

Some of the therapies include:

• Uterine massage, which helps your uterus' muscles contract.
• Contractions-stimulating medication.
• Eliminating uterine tissue that has been retained after delivery.
• Fixing uterine, cervical, and vaginal rips or abrasions.
• Sterilized gauze packing or cutting off the blood veins in your uterus.
• Applying pressure to your uterine walls with a catheter or balloon.
• Embolization of the uterine artery.
• Transfusion of blood.

Your doctor might conduct a hysterectomy or a laparotomy in exceptional circumstances or when other treatments don't work. To find the cause of the bleeding, your doctor will perform a laparotomy, which entails making an abdominal incision.

What Drugs are Used to Treat Postpartum Hemorrhage?

If uterine atony is the reason for the bleeding, you might be given medication to help trigger contractions. Oxytocin, methylergonovine, and prostaglandins, including carboprost and misoprostol, are the most often prescribed medications.

What can Postpartum Hemorrhage Complications be?

Increased heart rate, fast breathing, and decreased blood flow are just a few of the complications that excessive blood loss can bring on. Your liver, brain, heart, or kidneys may not receive enough blood due to these symptoms, which could result in shock.

Prevention

Who is Most Likely to Get Postpartum Hemorrhage?

PPH is most likely to affect women with placental issues such as placenta accrete, placenta previa, placental abruption, and retained placenta.

An overextended uterus further increases the risk of PPH. When your uterus is overstressed from:

• Having twins, triplets, or more.
• Delivering a big baby (9 pounds or more).
• An excessive amount of amniotic fluid.

Your risk of Hemorrhaging May Rise Due to the Following Reasons During Labor And Delivery:

• C-section.
• To induce labor, oxytocin (Pitocin®) was given to you.
• You were put under general anesthesia.
• Tocolytics were used to stop your labor.
• Protracted labor.
• A birth infection.
• Tearing (perineal lacerations) during vaginal birth.
• You've experienced PPH throughout previous pregnancies.

Additional health issues that can raise your risk of postpartum hemorrhage include:

• Disorders of blood coagulation or other illnesses involving blood.
• Pregnancy-related intrahepatic cholestasis (ICP).
• A history of five or more prior deliveries
• Mature maternal age.

How Can You Avoid Bleeding When Giving Birth?

The best strategy for healthcare providers to prevent postpartum hemorrhage is identifying high-risk people before birth. This depends on you telling your doctor everything about your symptoms and medical history. It's also crucial to regularly provide drugs like oxytocin to assist your uterus contract during labor. If postpartum hemorrhage does occur, ensuring appropriate iron consumption and red blood cell levels during pregnancy can lessen its effects.

Secondary postpartum bleeding (SPPH)

Any considerable vaginal bleeding 24 hours after placental birth and throughout the subsequent six weeks is referred to as secondary postpartum hemorrhage (SPPH). One of the most typical causes of readmission following delivery, SPPH, has been estimated to occur 0.2-0.8% of the time. Although fewer women are affected by SPPH than primary postpartum hemorrhage, it can result in serious complications if the diagnosis and proper therapies are put off. According to one study, up to 22% of SPPH patients needed to be admitted to the critical care unit.

Since that SPPH typically manifests itself during the second week following delivery, the timing of hospital release for most patients may contribute to the delay in SPPH's discovery.

Retention of the placenta, endometritis, and delayed placental bed involution are common causes of SPPH. Congenital coagulopathies, cervical cancer, submucous fibroids, placenta adherents, cesarean scar dehiscence, uterine pseudoaneurysm, and uterine rupture are some other less frequent aetiologies. The goal of the initial care is to stabilize the hemodynamics. So, the type of care depends on what caused the bleeding. If residual placental tissue is suspected, uterine evacuation typically treats the infection. Hysterectomy or arterial embolization may be advised in some situations, such as chronic bleeding, uterine perforation, and uterine pseudoaneurysm.