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Definition

What is postpartum haemorrhage?

Postpartum haemorrhage (PPH) is excessive bleeding after delivery, this will lead the cause of maternal mortality.

  • Primary PPH is when you lose more than 500ml (a pint) of blood within the first 24 hours after birth. It is common, affecting 5 in 100 women. Severe haemorrhage (more than 2 litres or 4 pints) is much less common, affecting only 6 in 1000 women.
  • Secondary PPH occurs when you have abnormal or heavy vaginal bleeding between 24 hours and 12 weeks after the birth. It affects fewer than 2 in 100 women.

How common is postpartum haemorrhage?

This health condition is extremely common. It commonly affects women who are over 35 years old. It can be managed by reducing your risk factors. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of postpartum haemorrhage?

The common symptoms of postpartum haemorrhage are

  • Excessive loss of bright red blood through the vagina after birth.
  • Lower abdominal pain.
  • Fever.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes postpartum haemorrhage?

In most cases, early postpartum haemorrhage occurs because the uterus is unable to contract sufficiently to constrict the blood vessels in its wall. This may be due to exhaustion of the muscles of the uterus after a prolonged labor, overstretching of the uterus as a result of multiple pregnancies, excess amniotic fluid or a large baby.

Contraction of the uterus may also be impaired by noncancerous growths in the uterus or if some or all of the placenta remains in the uterus after birth.

Risk factors

What increases my risk for postpartum haemorrhage?

There are many risk factors for postpartum haemorrhage, such as:

  • Having had a PPH in a previous pregnancy;
  • Having a BMI (body mass index) of more than 35;
  • Having had four or more babies before;
  • Carrying twins or triplets;
  • South Asian ethnicity;
  • Having a low-lying placenta (placenta praevia);
  • The placenta coming away early (placental abruption);
  • Pre-eclampsia and/or high blood pressure;
  • Anemia;
  • Delivery by caesarean section;
  • Induction of labor;
  • Retained placenta;
  • Episiotomy (a surgical cut to help delivery);
  • Forceps or ventouse delivery;
  • Laboring for more than 12 hours;
  • Having a big baby (more than 4kg);
  • Having your first baby if you are more than 40 years old.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is postpartum haemorrhage diagnosed?

If you are not already in the hospital, you will probably be admitted immediately. Your pulse and blood pressure will be monitored to look for any evidence of shock. If an early postpartum haemorrhage has occurred, your doctor will feel your lower abdomen to see if the uterus is contracted. The placenta will be checked to ensure that it is complete. If the uterus appears to be contracted but bleeding continues, your cervix and vagina will be examined. This may be carried out under general anaesthesia or epidural anaesthesia.

If you are having a late postpartum haemorrhage, your doctor may arrange for an ultrasound scan, using a probe inserted into the vagina, to check for remaining pieces of a placenta in the uterus. A vaginal swab may be taken to check for evidence of infection.

How is postpartum haemorrhage treated?

If an early postpartum haemorrhage is due to poor contraction of the uterus, you may be given an injection to help the uterus to contract. Your doctor may also massage your abdomen. If these measures do not work, further drugs may be given to help the uterus to contract.

If the bleeding continues, surgery may be required. In rare cases, a hysterectomy may be necessary. Bleeding caused by a retained placenta is treated by manually removing the remaining placenta through the vagina.

  • If the blood loss is due to tears in the cervix or vagina, these will be stitched.
  • If a late postpartum haemorrhage is the result of an infection,antibiotics will be prescribed.
  • If the bleeding continues, surgery may be needed to examine the uterus and remove any remaining fragments of a placenta. Blood lost due to a postpartum haemorrhage may have to be replaced by a blood transfusion.

High-quality evidence suggests that active management of the third stage of labor reduces the incidence and severity of PPH. Active management is the combination of uterotonic administration (preferably oxytocin) immediately upon delivery of the baby, early cord clamping and cutting, and gentle cord traction with uterine counter traction when the uterus is well contracted.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage postpartum haemorrhage?

The following lifestyles and home remedies might help you cope with postpartum haemorrhage:

  • Iron supplement. Taking iron supplements may reduce the likelihood of needing a blood transfusion if you have a PPH. Some women may also be offered iron supplements if they are at risk of anemia.
  • Set up an appointment with your doctor. If you have had a caesarean section in a previous pregnancy, it is important to check that the placenta has not attached itself to the area of the previous scar.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: January 4, 2017 | Last Modified: January 4, 2017

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