Postpartum hemorrhage is defined as blood loss of 500 ml or above as a result of child birth. It is the most common cause of maternal mortality worldwide. It’s a serious and life threatening but rare condition which usually happens between a days after having given birth but can also happen weeks after giving birth. About 1 to 5 in 100 women who have given birth (1 to 5 percent) have PPH. PPH can cause a severe drop in blood pressure which if not treated quickly, this can lead to shock and death even though it is normal to lose some blood after giving birth. Most women usually lose about half a quart (500 milliliters) during vaginal birth or about 1 quart (1,000 milliliters) after a cesarean birth. (Also called C-section) but with PPH, you can lose much more blood, which is what makes it a dangerous
condition.
Possible symptoms of postpartum hemorrhage may include:
• Heavy bleeding from the vagina that doesn’t slow or stop
• Drop in blood pressure or signs of shock. Signs of low blood pressure and shock include blurry vision; having chills, clammy skin or a really fast heartbeat; feeling confused dizzy, sleepy or weak; or feeling like you’re going to faint.
• Nausea (feeling sick to your stomach) or throwing up
• Pale skin
• Swelling and pain around the vagina or perineum. The perineum is the
area between the vagina and rectum.
You may be more likely than other women to have PPH if you have any of these conditions:
• Uterine Atony. This is the most common cause of PPH. It happens when the muscles in your uterus don’t contract (tighten) well after birth. Uterine contractions after birth help stop bleeding from the place in the uterus where the placenta breaks away. The placenta grows in your uterus and supplies the baby with food and oxygen through the umbilical cord. You may have uterine atony if your uterus is stretched or enlarged from giving birth to twins or a large baby (more than 8 pounds, 13 ounces). It also can happen as a result of prolonged labour, if you’ve already had several children, or you have too much amniotic
fluid (the fluid that surrounds your baby in the womb).
• Uterine inversion. This is when the uterus turns inside out after birth.
• Uterine rupture. This is when the uterus tears during labour. It happens rarely. It may happen if you have a scar in the uterus from having a C-section in the past or if you’ve had other kinds of surgery on the uterus.
• Placental abruption. This is when the placenta separates from the wall of the uterus before birth. It can separate partially or completely.
• Placenta Accreta, placenta increta or placenta percreta. These conditions happen when the placenta grows into the wall of the uterus too deeply.
• Placenta Previa. This is when the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina.
• Retained placenta. This happens if you don’t pass the placenta within 30 to 60 minutes after you give birth. Even if you pass the placenta soon after birth, your provider checks the placenta to make sure it’s not missing any tissue. If tissue is missing and is not removed from the uterus right away, it may cause bleeding.
• Having a C-section
• Getting general anesthesia. This is medicine that puts you to sleep so you don’t feel pain during surgery. If you have an emergency C-section, you may need general anesthesia.
• Induced labor: Providers often use a medicine called Pitocin to induce labour. Pitocin is the man-made form of oxytocin, a hormone your body makes to start contractions.
• Taking medicines to stop contractions during preterm labour
• Tearing (also called lacerations). This may happen if the tissues in your vagina or cervix are cut or torn during birth. The cervix is the opening to the uterus that sits at the top of the vagina. You may have tearing if you give birth to a large baby, your baby is born through the birth canal too quickly or you have an episiotomy that tears. An episiotomy is a cut made at the opening of the vagina to help let the baby out. Tearing can also happen if your provider uses tools, like
forceps or a vacuum, to help move your baby through the birth canal during birth. Forceps look like big tongs. A vacuum is a soft plastic cup that attaches to your baby’s head. It uses suction to gently pull your baby as you push during birth.
• Having quick labour or being in labour a long time. Child birth delivery is different for every woman. If you’re giving birth for the first time, labour usually takes about 14 hours. If you are not a prime, it usually takes about 6 hours or less.
Postpartum Hemorrhage can be prevented through the following;
Correct anemia before childbirth. Identifying and correcting the presence of anemia before child birth can go a long way towards preventing postpartum hemorrhage.
• Anemia is a strong precursor hemorrhage, due to the lack of iron in
the blood inhibiting blood clotting.
• The effects of anemia can be managed by increasing your iron intake throughout the course of your pregnancy.
• Using iron supplements and consuming foods that are rich in iron (green leafy vegetables with vitamin C) are a good way to boost your levels of iron.
Eliminate routine episiotomy. If you are undergoing episiotomy, it should be eliminated because laceration and other forms of trauma can greatly increase your risk of postpartum hemorrhage.
• This can only be done if the perineum is a limiting factor in child birth and delivery. Make sure your vital signs are monitored to ensure safety and prevent
shock. You should make sure your vital signs are thoroughly evaluated and monitored before being discharged from the delivery room.
• A sudden change in your vital signs (blood pressure, heart rate, respiratory rate) can indicate that you are going through shock, which can be a complication of postpartum hemorrhage.
• Doctors and nurses should make sure that all your vital signs are stable before rooming you into a recovery area or a general ward. Monitor your vaginal blood flow. Vaginal flow must also be monitored to ensure that you notice hemorrhage immediately.
• A significant increase in blood flow is only the tip of the iceberg as it only reveals a tiny part of what is actually happening inside your body during hemorrhage.
Monitor your third stage of labour to prevent the onset of hemorrhage. Active management of the third stage of labour is the best preventive strategy that should be used. This involves the administration of uterotonic medications immediately after delivery, controlled cord traction, and early cord clamping and cutting.
By Mercy Kukah
