Postpartum Haemorrhage : Key Information

Bringing a new life into this world is often filled with joy, but it can also bring unexpected challenges for new mothers. One of these is postpartum haemorrhage (PPH)—a serious and potentially life-threatening complication that can happen suddenly after childbirth. While most new mothers recover smoothly, PPH can strike without warning, turning what should be a peaceful time into an emergency.

Take Richa for example. Shortly after giving birth to her daughter, she found herself battling PPH unexpectedly. What began as heavy bleeding soon turned critical. She did not understand what was going on as her pregnancy and delivery went smoothly. Thankfully, with prompt medical attention, she recovered. But, the experience left her shaken and aware of how little she knew about PPH beforehand.

PPH is a serious condition that can affect any new mother, yet many don’t fully understand the risks. Richa’s experience reminds us that understanding PPH and its potential risks can make a difference in saving lives.
 

PPH is a condition that occurs when a woman experiences heavy bleeding after giving birth. For new mothers like Richa, it can be an unexpected and overwhelming experience. While it’s normal to lose some blood after delivery, PPH involves a much greater loss of blood, which can lead to serious complications if not treated promptly.

It typically happens within 24 hours of birth but can also occur later. For Richa, the sudden onset of bleeding after she thought everything was fine is what caught her and her family off guard. Knowing the signs and understanding the condition can empower new mothers to act quickly. 

Definition and Blood Loss Thresholds

PPH is defined as blood loss of more than 500 ml after a vaginal delivery or more than 1,000 millilitres after a caesarean section, as defined by the World Health Organization (WHO). In simple words, PPH is when a new mother loses a lot of blood after giving birth. This much blood loss can be dangerous, so it's important to get medical help right away if it happens.

In severe cases, like Richa’s, the blood loss can exceed these thresholds, leading to shock, organ damage, or even death if not treated. It's crucial to understand these numbers to differentiate between normal postpartum bleeding and PPH.

There are several causes of PPH, and knowing them can help identify potential risks early on. For some mothers, the bleeding may begin without much warning, but for others, certain conditions can increase the likelihood of PPH. Some common causes of PPH include:

• The uterus not contracting properly after birth (uterine atony)
• Tears or injury to the birth canal during delivery
• Retained placenta or tissues in the uterus
• Blood clotting disorders that make it difficult for the body to stop the bleeding

Recognising these causes can help ensure quicker treatment and a safer recovery for new mothers. Let us look at a few causes in detail.

Uterine Atony and Contributing Factors

The most common cause of PPH is uterine atony. This happens when the uterus (the organ where the baby grows during pregnancy) doesn’t contract (go back to its original size) properly after childbirth. Normally, after the baby is born, the uterus tightens or contracts to squeeze the blood vessels and stop any bleeding. It’s like when you press on a cut to stop it from bleeding.

In some cases, the uterus does not contract as it should, which allows too much blood to flow out, leading to excessive bleeding. This failure to contract or uterine atony can be caused by things like:

• A long or difficult labour
• Overstretched uterus due to a large baby or multiple pregnancies
• Exhaustion from labour
• Use of certain medications during labour

All of these can make the uterus too tired to tighten up. When the uterus doesn't contract, doctors need to act quickly to help stop the bleeding.

Trauma, Tissue Issues, and Coagulopathy

There are other reasons why PPH might happen, and it's helpful for new moms to be aware of these without feeling overwhelmed. It’s important to remember that doctors and nurses are well-prepared to handle these situations.

• Trauma: Sometimes, during delivery, the birth canal can get small injuries, especially if tools like forceps or a vacuum are used to help the baby come out. These small injuries can cause extra bleeding, but doctors know how to manage this and will take steps to stop the bleeding quickly.
• Tissue Issues: After the baby is born, the placenta (which nourished the baby during pregnancy) needs to come out too. If any small pieces of the placenta or other tissues stay inside, the uterus might not tighten up as it should, which can lead to more bleeding.
• Coagulopathy: Some women might have conditions that make it harder for their blood to clot (or stop bleeding). This is called a clotting disorder, and while it sounds concerning, medical teams are trained to identify and treat it so the bleeding stops.

It's important to remember that most moms recover well, and medical care is there to help guide moms safely through this process.

• While some women may experience PPH without any complications during pregnancy, certain factors can increase the risk. Understanding these can help moms and their families be more aware and prepared.
• Risk factors include:
• Long or difficult labour, which can tire out the uterus.
• Having a very large baby or giving birth to twins or triplets.
• Previous history of PPH or surgeries on the uterus.
• Use of tools like forceps or a vacuum during delivery.

Even with these risks, doctors monitor moms closely to ensure safe outcomes.

Prolonged Labour and Other Obstetric Factors

• Prolonged labour: Sometimes, labour can take a long time, lasting many hours. This can make the uterus very tired and unable to contract properly after the baby is born, which increases the risk of heavy bleeding.
• Caesarean section (C-section): Delivering a baby through surgery instead of the usual vaginal delivery carries a higher risk of PPH. This is especially true if the C-section was unexpected or if it happened after a long labour.
• Multiple pregnancies: When you’re carrying twins, triplets, or more, your uterus gets stretched more than usual. After delivery, it may have a harder time contracting back to its normal size, which can lead to more bleeding.
• Placental abnormalities: In some cases, the placenta (which nourishes the baby during pregnancy) might not be in the right place or may separate from the uterus too early. Conditions like placenta previa or placental abruption can increase the risk of PPH during and after delivery.

By understanding these risks, both you and your healthcare team can be better prepared to manage any complications.
 

PPH can develop quickly, so it’s important to recognise the signs early.

Signs and symptoms to watch for include:

• Heavy, uncontrollable bleeding
• Dizziness or light-headedness
• Rapid heart rate
• Pale or clammy skin
• Difficulty breathing

If you or someone you know experiences any of these symptoms after childbirth, it’s essential to seek immediate medical attention.
 

One of the best ways to prevent PPH is through careful management during the third stage of labour, which is when the placenta is delivered after the baby is born. This stage is vital to ensuring that the uterus contracts properly, helping to prevent excessive bleeding. Some steps involved in this management include:

• Administering uterotonic medications: These are special medications given to help the uterus contract effectively after delivery.
• Controlled cord traction: This means gently pulling on the umbilical cord to help guide the placenta out safely.
• Immediate clamping of the umbilical cord: Clamping the cord quickly can help reduce the amount of blood that might flow back into the placenta.

By following these steps, the risk of PPH can be significantly reduced, helping new mothers feel more secure.
 

If PPH does occur, it’s essential to get treatment quickly. If the bleeding continues despite medications, they may need to consider surgical options. Here are some treatment methods:

• Medications: Uterotonic drugs are given to help the uterus contract better, which can help control the bleeding.
• Surgery: In more severe cases, surgery might be necessary to remove any remaining tissue in the uterus. In extreme situations, a hysterectomy (removal of the uterus) may be required to save the mother’s life.
• Blood transfusion: If there’s a significant loss of blood, a transfusion can be life-saving, giving the body the blood it needs to recover.

It’s important to remember that medical teams are well-prepared to handle these situations and provide the care needed for a safe recovery.

Richa’s experience underlines the importance of quick action when it comes to PPH. Had the medical team not acted swiftly, the outcome could have been far worse.

PPH is a condition that requires immediate attention. New mothers and their families should be aware of the signs, potential causes, and the importance of speaking up if something doesn’t feel right. Early recognition and treatment are key to ensuring a safe recovery and the chance to enjoy the precious moments of motherhood.

Richa’s story is a reminder that even when the unexpected happens, there is hope. With proper care and awareness, new mothers can navigate postpartum complications like PPH with strength and support.