Post partum hemorrhage (PPH) is excessive and heavy bleeding from uterus after childbirth. Normally some amount of blood is lost at the time of delivery; it is about 500 ml following vaginal birth or 1000 ml following cesarean section. With PPH the amount of blood loss is much more. Post partum hemorrhage is considered to be one of the prominent causes of death related to pregnancy world over. It is also an important cause of pregnancy related morbidity.
Post partum hemorrhage can occur within 24 hours after child birth or within 6 to 12 weeks after delivery.PPH causes severe drop in blood pressure due to blood loss, besides many other symptoms. If left untreated, it is life threatening condition.
Causes & Risk Factors For Postpartum Hemorrhage
After the baby is delivered, contraction continues to push out the placenta attached to the uterus. Once the placenta is removed contractions still continue which helps to build up pressure on the bleeding blood vessels of uterine cavity. This pressure helps the bleeding to stop. However, in some cases the uterus does not contract strongly (uterine atony), which causes the blood vessels to bleed continuously.This is the commonest reason of post partum hemorrhage.
In some cases bits of placenta or product of conception are still left behind in the uterus which may continue to bleed. Besides these main reasons, various other problems such as a tear in cervix or vagina, damage to the blood vessels of uterus, abnormal coagulation disorders, and problems related to placenta can cause post partum hemorrhage.
There are some pregnant women who may be at greater risk for post partum hemorrhage. Certain conditions that increase the risk factor are:
- Women with multiple pregnancies.
- Detachment of placenta earlier than its normal time.
- Enlarged uterus because of large baby or excessive amniotic fluid.
- High blood pressure during pregnancy.
- Obese women.
- Uterine fibroid.
- Delivery with the help of instruments such as forceps or vacuum.
- Previous history of cesarean section.
- Prolonged time taken for rupture of membranes or labor.
- Past history of post partum hemorrhage.
- Being women of Asian or Hispanic origin.
- Infection such as chorioamnionitis.
- Rupture of uterus.
Symptoms Of Postpartum Hemorrhage
Post partum hemorrhage usually occurs without any warning. Here are following signs and symptoms that may indicate PPH.
- Uncontrolled heavy bleeding from vagina after delivery. It may be within 24 hours or later on within 6 to 12 weeks.
- Low blood pressure due to loss of blood.
- Rapid pulse and heart rate.
- Feeling as if she is going to faint.
- Cold and clammy skin.
- Pain and swelling in perineum due to formation of a hematoma. Perineum is a space between vagina and anus.
- Skin and tongue becomes pale.
- Confusion and dizziness.
Diagnosis And Treatment Of Postpartum Hemorrhage
Diagnosis of post partum hemorrhage is made by the doctor. He will review the history and assess the condition of patient after examining her. Laboratory tests will be helpful for purpose of diagnosis. He will take into consideration certain vital parameters such as low blood pressure, pulse rate and the amount of blood lost. He may count the number of pads that were used to soak the blood from vagina. Blood tests such as hemoglobin estimation and clotting factor test will be useful for diagnosis of PPH.
The first and prime important treatment measure is to stop the bleeding and simultaneously address the underlying cause as early as possible. Treatment measures include:
- Massage the uterus to increase the contractions of uterus.
- Administering medicines that will help to contract uterus.
- He will put a catheter in the urinary bladder to keep it empty. A full bladder makes it difficult for the uterus to contract.
- If the placenta has retained inside the uterus, he may try to remove it manually inserting his hand inside the uterus.
- Introducing Folye catheter inside the uterus to build up pressure on the bleeding vessels.
- Use sponges and pads to pack the uterus.
- Patient may need blood transfusion besides intravenous fluids if bleeding is too much.
- Very rarely surgical procedure such as abdominal hysterectomy may be needed.