Postpartum Haemorrhage: What Should You Know?

Obstetrics and Gynaecology | Posted on 09/09/2024 by Dr. Namrata Gupta

Introduction 

Women immediately after delivery experience blood loss as the placenta separates from the uterus. It happens because open blood vessels start bleeding as soon as the placenta begins the separation. Once the placenta is delivered, the uterus contracts and closes the open blood vessels. Since the blood during pregnancy increases by 50%, females are ready to lose this blood. However, some females might experience excessive bleeding after delivery that needs clinical attention. So, if you have delivered the baby, chances are you may not have heard the term postpartum haemorrhage.

Postpartum haemorrhage (PPH) is losing too much blood after delivery and it occurs in approximately 6% of women. This type of obstetric haemorrhage is a medical emergency and must be addressed immediately to prevent severe complications. If you have been passing more than 500 ml of blood from your vagina after birth to a baby, you must consult a gynaecologist in Jaipur immediately because it indicates postpartum haemorrhage. It is a medical emergency and you must call your doctor to prevent blood loss. Most women aren’t aware of the postpartum haemorrhage causing life-threatening problems. 

Key Facts

In this write-up, we will discuss this in detail but before we go forward, let’s have a look at some of the key facts.

• Postpartum haemorrhage condition is when a female loses a huge amount of blood after giving birth to a baby. This is a serious and dangerous condition.
• Females experience this issue when the uterus is unable to contract appropriately after the birth of a baby. It can also happen due to infection.
• The condition is not predictable and anyone can experience the problem. Hence, women giving birth should have immediate emergency access.
• The doctor usually gives an injection for the uterus contraction so that the placenta comes out and it assists in reducing the risk of postpartum haemorrhage.
• There might be a requirement for medicines, blood transfusion, and even surgery to prevent bleeding.

What is postpartum haemorrhage?

Postpartum haemorrhage, also referred to as PPH, is identified as one of the serious and rare reproductive conditions among females. It causes them to bleed without control after the birth of a baby. Usually, it occurs within a day after the baby is born and can occur for around twelve weeks.

However, it is normal for women to bleed after giving birth but when it gets out of control, then it is a serious problem. Women can experience a huge drop in blood pressure if there is significant blood loss. Organs don’t get sufficient blood flow supply and eventually cause shock leading to even death. This condition can be exacerbated by haemorrhage during birth, such as haemorrhage after a C-section.

What Are the Types of Postpartum Haemorrhage?

Two types of postpartum haemorrhage are there:

• Primary postpartum haemorrhage: Women experience this type within 24 hours after giving birth to a baby.
• Secondary postpartum haemorrhage: Females can experience this type that occurs 24 hours to 12 weeks.

What Are the Symptoms of Postpartum Haemorrhage?

Yes, different postpartum haemorrhage symptoms are there but every female might experience them differently. If you aren’t mindful of the symptoms, then have a look at the common symptoms:

Fig 1: Postpartum Haemorrhage 

What Are the Causes of Postpartum Haemorrhage?

Some females are more at risk of postpartum haemorrhage than other females due to some causes or conditions. So, it is essential to be aware of those postpartum haemorrhage causes which are:

• One of the main causes is placental abruption which means the detachment of the placenta from the uterus in the early stage.
• Placenta Previa is another reason that indicates either the placenta is covered or is around the cervical opening.
• Overstretched uterus causes too much uterus enlargement because of a huge baby or excessive amniotic fluid.
• When there are multiple pregnancies, then it leads to postpartum haemorrhage caused due to extreme uterus stretching.
• If the woman has already given multiple births earlier, then also it causes postpartum haemorrhage.
• The unusual timing of labour.
• Infection, obesity, medications to induce labour, and stop contractions are among other causes of postpartum haemorrhage.

Other postpartum haemorrhage causes

There can be other postpartum haemorrhage causes which include:

• Vaginal tissue or cervix tear
• Uterus blood vessel tear
• Unusual bleeding in the hidden areas like the vagina or vulva
• Placenta issues and blood clot disorders

How common is postpartum haemorrhage?

Since postpartum haemorrhage is a rare condition, not every woman experiences this problem. It occurs in around 1- 10% of pregnancy cases. Females can experience the condition within a day after giving birth, however, it can occur up to twelve weeks after the delivery. If we talk about the numbers, then around 1 to 5 in 100 females have PPH.

Can you have another baby after postpartum haemorrhage?

Females who bleed more than usual while giving birth to a baby are not at a higher risk of experiencing complications when they plan to have another baby. However, it doesn’t mean that there are no chances of postpartum haemorrhage next time. So, it becomes important that one must speak to your doctor during their next pregnancy journey as they can help in preventing PPH beforehand.

How does uterine atony cause postpartum haemorrhage?

Uterine atony is identified to be among the causes of postpartum haemorrhage as it forms the soft and weak uterus after the baby's birth. It happens when the uterine muscles are unable to contract enough to plant the placental blood vessels shut. It causes steady blood loss after the delivery.

Uterine atony is an inappropriate corpus uteri myometrium cell contraction in revert to the endogenous oxytocin release. It can happen as spiral arteries are differently devoid of musculature reliant on the contractions for squeezing them into haemostasis.

How is Postpartum Haemorrhage Diagnosed?

To detect excessive blood loss after childbirth, postpartum haemorrhage (PPH) is diagnosed using a mix of clinical observations and medical tests:

• Visual Assessment: Helps to monitor excessive vaginal bleeding.
• Vital Signs Monitoring: It helps identify low blood pressure, augmented heart rate, and symptoms of shock.
• Physical examination: The uterus is palpated to determine its location and tone.
• Laboratory tests: Hematocrit and haemoglobin levels are measured to ascertain blood loss.
• Ultrasonography: Assist in recognizing uterine anomalies or retained placental pieces.
• Tests for blood coagulation: Helps evaluate clotting ability to exclude coagulopathy. 

What Are the Treatment Options for Postpartum Haemorrhage?

The doctor will involve treatment options for the management of postpartum haemorrhage. So, he/she will begin the postpartum haemorrhage diagnosis:

• There will be an evaluation of the female’s health history, complete health, and pregnancy.
• The doctor will try identifying the postpartum haemorrhage condition severity.
• The tolerance of a female for varied medications and treatments.
• The doctor will try to understand the female’s point of view and identify their requirements regarding the treatment.

The objective is to stop you from bleeding so here is the treatment your doctor might give you:

• Medications
• Uterus massage to begin contractions
• Placenta pieces are removed if there are any in the uterus after delivery
• Uterus and pelvic tissue evaluation
• Sterile materials and sponges are used to pack the uterus
• Surgical removal of the uterus might be considered in severe cases.

Final thoughts

Postpartum haemorrhage is a serious and rare condition that needs clinical attention immediately after delivery. If you have delivered the baby recently or are about to deliver, then ensure to speak to your doctor beforehand so that necessary steps are taken to prevent the risk of postpartum haemorrhage. PPH can be life-threatening and it is essential to involve treatment options to manage the symptoms. Early diagnosis and treatment are useful in mitigating complications. Hence, you must stay in contact with your doctor and should tell them everything about your medical history. It will help the doctor determine the severity of the condition and if you are at higher risk.

FAQs

How long does postpartum haemorrhage last?

The postpartum condition lasts for around four to six weeks but in rare cases, it might take up to 12 weeks.

Who is at the highest risk for postpartum haemorrhage?

Females with placental issues are identified to be at a higher risk for postpartum haemorrhage. These issues are placental abruption, retained placenta, and placenta Previa. 

If you haemorrhage after giving birth, will it happen again?

Yes, having a previous postpartum haemorrhage (PPH) increases the risk of it happening in future pregnancies.

Is it safe to have another baby after a postpartum haemorrhage?

Yes, but with subsequent pregnancies, it's crucial to have a thorough plan and constant supervision. When making plans for another child, consulting a healthcare provider is essential. 

Does postpartum haemorrhage affect future pregnancy?

PPH can raise the risks of subsequent pregnancies, however, women who receive appropriate treatment can achieve healthy pregnancies. 

What are the chances of haemorrhaging twice?

Recurrent PPH carries a 15% probability, though this can vary depending on personal circumstances.