Postpartum Hemorrhage (PPH) is a condition in which a pregnant woman loses more than 1 liter of blood after childbirth or so much that it causes physical symptoms. Symptoms can occur in two ways: within 24 hours after delivery and 24 hours–12 weeks after delivery.
Postpartum hemorrhage can happen to anyone who has just given birth, regardless of the delivery method used by the doctor. It is a serious condition that should be treated immediately because if it is not treated properly, it can put the patient at risk of death. In Thailand, postpartum hemorrhage is one of the leading causes of death among pregnant women.
Postpartum hemorrhage
Symptoms of postpartum hemorrhage vary, but the main symptom is prolonged, profuse vaginal bleeding.
Other symptoms that may occur include dizziness, nausea, vomiting, blurred vision, chills, fatigue, rapid heartbeat, shortness of breath, paleness, cold skin, swelling of the vagina, pain in the abdomen or pelvis, confusion, or feeling restless, etc.
In the early stages of blood loss, the body may not show any abnormal symptoms. Therefore, the doctor must monitor the symptoms of the mother who has just given birth periodically after delivery because if any signs of postpartum hemorrhage are found, treatment can be given immediately.
However, those who have just given birth and have been allowed to go home by the doctor should always monitor their body changes. If they start to experience any of the above symptoms, they should see a doctor immediately.
Causes of postpartum hemorrhage
During pregnancy, the body creates a placenta to help transport nutrients and oxygen, as well as to remove waste from the baby. One side of the placenta is attached to the mother’s uterine wall, while the other side is attached to the baby’s umbilical cord.
After delivery, the uterus will start to shrink back to its normal size as a natural mechanism by the body to help stop the bleeding. During this time, the doctor will massage the uterus to help the uterus contract and remove the placenta.
However, some people may find that the bleeding continues to flow from the vagina, leading to postpartum hemorrhage. Common causes include:
- Uterine contractions that are not strong enough to stop the bleeding are a common cause.
- Damage to the vagina, cervix, uterus, or perineum from the use of instruments to assist with birthing.
- There is an abnormality of the placenta, such as a partial placenta remaining in the uterus, an abnormal placenta positioned in the uterus, or a placenta accreta.
- Suffering from a blood clotting disorder
In addition, there are some risk factors that may increase your risk of postpartum hemorrhage, such as:
- The uterus is abnormally enlarged. Common causes include multiple births, twins, giving birth to very large babies, and the body having an abnormal amount of amniotic fluid.
- Long-term delivery
- Cesareansection (C-Section)
- Episiotomy to assist birth
- Have a history of postpartum hemorrhage
- Those who have given birth many times, especially those who have given birth more than 5 times.
- Pregnancy after age 35
- Have a large uterine fibroid
- Use of certain medications, such as labor-inducing drugs, anticonvulsants, or anesthesia.
- Other abnormalities such as being overweight, high blood pressure, preeclampsia, anemia, intrahepatic cholestasis of pregnancy, or infection.
Diagnosis of postpartum hemorrhage
To diagnose postpartum hemorrhage, a doctor will review the patient’s history, assess the amount of blood loss, and measure vital signs, such as pulse, blood pressure, blood oxygen levels, and breathing.
Other methods may also be used at the doctor’s discretion, such as blood tests to check the amount of blood cells in the body and signs of blood clots, and ultrasounds of the uterus or other organs to allow the doctor to see more details.
Treatment of postpartum hemorrhage
Initially, before treating a patient with postpartum hemorrhage, the doctor will check the patient’s vital signs, such as pulse, blood pressure, breathing, and body temperature, and treat the abnormalities found first to stimulate the patient’s vital signs.
Doctors will treat postpartum hemorrhage in patients to help stop the bleeding and replace the lost blood as quickly as possible. Doctors will consider the treatment method based on the cause and suitability for each patient, such as:
Uterine massage or medication
The doctor will massage the patient’s uterus or may use certain medications if the patient’s uterine contractions are not strong enough to stop the bleeding, such as oxytocin , to make the patient’s uterus contract and stop the bleeding. While the doctor is massaging the uterus, the doctor may also check for any remaining placenta or remove any blood clots.
D&C
In patients with placenta previa, the doctor may consider performing a D&C to remove the remaining placenta in the uterus.
Use of medical devices or suturing wounds
In patients with bleeding from wounds, the doctor may insert a sponge or some medical devices into the uterus to help stop the bleeding or may consider stitching the wound, depending on the discretion of the treating doctor and the appropriateness for each patient.
Insertion of a tube
The doctor may consider inserting a catheter to drain the patient’s urine, as a full bladder makes it harder for the uterus to contract.
Surgery
Surgery is only used if the patient has not responded to other treatments or is at high risk of death. The doctor may decide, together with the patient, to perform a hysterectomy to remove the uterus.
After the bleeding has stopped, the doctor may prescribe other treatments until the patient’s condition stabilizes to prevent shock, such as fluids, blood transfusions, or certain medications.
Complications of postpartum hemorrhage
Untreated postpartum hemorrhage can lead to complications from blood loss, including dizziness upon standing, fatigue, anemia, shock, and even death.
In addition, postpartum hemorrhage may also cause the patient to develop Sheehan Syndrome or may increase the risk of serious conditions such as myocardial ischemia if the condition is severe.
Prevention of postpartum hemorrhage
Those who are about to give birth should inform the doctor of their health history in detail, especially their blood type, history of diseases or conditions related to blood clotting, or history of postpartum hemorrhage, so that the doctor can consider the risks and prepare for the birth appropriately.
