Postpartum Haemorrhage

By Medically reviewed by Panel Perubatan Hello Doktor

In this article:

  • Knowing the basics
  • Identifying the symptoms
  • Determining the causes
  • Reducing the risk factors
  • Understanding the treatment
  • Treating the condition through lifestyle changes & home remedies

Knowing the basics

What is postpartum haemorrhage?

Postpartum haemorrhage (PPH) is excessive bleeding after labour that may result in maternal mortality. The condition can be divided into 2 types based on the time factor of incident:

  • Primary postpartum haemorrhage: More than 500 ml of blood loss within the first 24 hours after giving birth. About 1 in 20 women experience this condition. Severe cases are less common, with only 3 out of 500 have it.
  • Secondary postpartum haemorrhage: Heavy bleeding and vaginal abnormalities from the first 24 hours to 12 weeks after birth. 1 in 50 women have this condition.

Identifying the symptoms

What are the signs and symptoms?

Common symptoms include:

  • Uncontrolled bleeding
  • Reduced blood pressure
  • Increased heart rate
  • A reduce in red blood cell count
  • Swelling and pain in the vagina and surrounding areas 

There may be other symptoms that could show up when you have PPH. Please consult a doctor if you experience any abnormalities. 

Determining the causes

What causes postpartum haemorrhage?

In most cases of PPH, the uterus does not contract strongly enough due to heavy labour, overdistended uterus, multiple-baby pregnancy, excess of amniotic fluid or a large baby. Sometimes, the development of a benign tumor or a retained placenta can affect the contractility of the uterus.

Reducing the risk factors

Who is at risk of postpartum hemorrhage?

This condition is very common in women over 35 years old. You can control this disease by minimising its risk factors. Please consult a doctor for more details.

What factors increase the risk of postpartum haemorrhage?

There are many factors that increase the risk of developing PPH, such as:

  • Experiencing postpartum haemorrhage in previous pregnancy
  • Obesity
  • Multiple previous births
  • Multiple-baby pregnancy
  • Being of Asian ethnic background
  • Placenta praevia: A condition where the placenta covers or is close to the opening of the cervix.
  • Placental abruption: Early detachment of the placenta from the uterus.
  • Having pre-eclampsia or high blood pressure
  • Anemia
  • Caesareans section
  • Labor induction
  • Retained placenta
  • Episiotomies
  • Use of forceps or vacuum-assisted delivery
  • Prolonged labor (more than 12 hours)
  • Newborn weighing over 4 kg
  • Having your first child when you are over 40.

Understanding the treatment

The information provided herein is not a substitute for any medical advice. Therefore, ALWAYS consult a doctor for more information.

How is postpartum haemorrhage diagnosed?

When at home, you need to immediately monitor your pulse rate and blood pressure to look for signs of shock. If PPH occurs early, the doctor would feel around the lower abdomen to check if the uterus contracts. They then need to make sure that there is no placenta remaining in the womb. If the cervix is closed but there is vaginal bleeding, anesthesia or epidural anesthesia would be carried out for further examination.

If you experience secondary PPH, the doctor would do an ultrasound by inserting a transducer into your vagina to check for any retained placenta in the uterus. They may take a vaginal swab to check for infection.

How is postpartum haemorrhage treated?

If the primary postpartum haemorrhage is due to weak uterus contractility, the doctor would inject a hormone to help the uterus contract or give you a uterine massage to help stimulate uterine contractions. If the uterus continues to bleed, you may need to undergo a laparotomy or even a hysterectomy in rare cases. A procedure to remove pieces of placenta that remain in the uterus might be performed.

  • If the cause is a tear in the uterus or vagina, the doctor will close the old incision.
  • If the cause is an infection, antibiotics will be prescribed.
  • If the bleeding continues, the doctor will need to perform surgery to examine the uterus and remove the remaining placenta. Blood loss due to postpartum haemorrhage requires blood transfusion.

Early care during pregnancy helps reduce the severity and incidence of postpartum haemorrhage. If postpartum haemorrhage is suspected, the umbilical cord needs to be clamped and cut right away after delivery. 

Treating the condition through lifestyle changes & home remedies

Which lifestyle habits help you slow the progression of postpartum haemorrhage?

You will be able to control or prevent PPH if you regard the following:

  • Iron supplementation: Iron supplements may limit your chance to have a blood transfusion when you experience postpartum haemorrhage. In general, women should also take iron supplements if they are at risk of iron-deficiency anaemia.
  • Visit your doctor regularly: If you have had a caesarean section in a previous pregnancy, the placenta would be more likely to attach onto the scar tissue in the uterus.

If you are concerned about any red flags with your health, please consult a doctor for advice on the best treatment.

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

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