Postpartum Haemorrhage: Causes, Symptoms & Emergency Signs

 

What is Postpartum Haemorrhage?

Postpartum haemorrhage refers to excessive bleeding after childbirth. It can occur within the first 24 hours (primary or early PPH) or up to 12 weeks after delivery (secondary or late PPH). While a certain amount of blood loss is normal after birth, PPH involves significantly more, posing a serious risk to the mother's health if not promptly addressed.

Understanding the Causes of Postpartum Haemorrhage

Effective management of PPH begins with understanding its root causes. The major causes of postpartum haemorrhage can be categorised using the "Four T's" mnemonic, which helps healthcare providers quickly identify and address the issue:

Tone (Uterine Atony)

• This is the most common cause, accounting for a majority of the PPH cases. After the baby is born, the uterus normally contracts strongly to compress the blood vessels that were connected to the placenta. If the uterus does not contract effectively (uterine atony), these vessels continue to bleed, leading to significant blood loss.

• Risk Factors: Over-distended uterus (due to large baby, twins, or excess amniotic fluid), prolonged labour, rapid labour, high parity (many previous births), or infections

Trauma (Lacerations or Hematomas)

• Trauma to the birth canal can cause bleeding. This includes tears (lacerations) in the cervix, vagina, or perineum or go unnoticed.

• Risk Factors: Rapid delivery, instrumental delivery (forceps or vacuum), episiotomy, or having a large baby.

Tissue (Retained Placental Tissue)

• If parts of the placenta remain inside the uterus after delivery, they can prevent the uterus from contracting properly, leading to bleeding.

• Risk Factors: Placenta accreta (placenta grows too deeply into the uterine wall), previous C-sections, or a delayed third stage of labour.

Thrombin (Coagulopathy)

• Problems with the mother's blood clotting ability (coagulopathy) can also lead to excessive bleeding. This can be pre-existing or develop due to complications of pregnancy such as severe pre-eclampsia or placental abruption.

• Risk Factors: Pre-existing clotting disorders, severe infections, or conditions that consume clotting factors.

Recognising Postpartum Haemorrhage Symptoms & Emergency Signs

Early detection is paramount in managing PPH effectively. While medical professionals closely monitor mothers after delivery, new mothers need to be aware of postpartum haemorrhage symptoms so they can communicate any concerns promptly.

Common Symptoms of Early PPH

• Heavy Vaginal Bleeding: Soaking through more than one sanitary pad per hour, or passing large blood clots (larger than a golf ball).

• Light-headedness or Dizziness: A feeling of faintness, especially when standing up.

• Increased Heart Rate: Your heart may beat faster as it tries to compensate for blood loss.

• Drop in Blood Pressure: Though this might be checked by medical staff.

• Pale Skin: A noticeable paleness due to reduced blood volume.

• Feeling Weak or Tired: Unusual fatigue beyond the normal postpartum exhaustion.

Late Postpartum Haemorrhage Signs and Symptoms (Secondary PPH)

Bleeding can also occur days or even weeks after delivery. These are typically less common but still require immediate attention.

• Persistent, Heavy Vaginal Bleeding: Bleeding that suddenly increases in volume or lasts longer than expected (usually beyond the first week, and heavier than typical lochia).

• Passing Large Blood Clots: Clots larger than a lemon.

• Fever: This could indicate an infection, which can be a cause or complication of late PPH.

• Abdominal Pain: Persistent cramping or pain in the lower abdomen.

• Unpleasant Vaginal Odour: A foul-smelling discharge, often associated with infection.

Any of these symptoms, particularly heavy bleeding, should be reported to your healthcare provider immediately. Do not hesitate to seek emergency care if you suspect PPH.

Effective Postpartum Haemorrhage Treatment

When PPH occurs, rapid and effective intervention is critical. Healthcare facilities are equipped with state-of-the-art resources and highly skilled teams of obstetricians, anaesthesiologists, and critical care specialists ready to provide immediate and comprehensive treatment. A multidisciplinary approach ensures the best possible outcomes for mothers. The Department of Obstetrics and Gynaecology at Manipal Hospitals Goa provides expert maternal care with timely evaluation, emergency management, and personalised support for postpartum complications

Immediate Interventions

• Uterine Massage: Manual massage of the uterus helps it contract and stop bleeding.

• Medications: Specific medications are administered to stimulate uterine contractions.

• Fluid Resuscitation: Intravenous fluids are given to replace lost blood volume and maintain blood pressure.

• Blood Transfusion: If significant blood loss has occurred, a blood transfusion may be necessary.

Advanced Procedures

• Removal of Retained Placental Tissue: If tissue is identified, it will be carefully removed to allow the uterus to contract.

• Repair of Lacerations: Any tears in the birth canal are sutured to stop bleeding.

• Uterine Balloon Tamponade: A special balloon is inserted into the uterus and inflated to apply pressure and stop bleeding.

• Uterine Artery Embolisation: In more complex cases, radiologists can block the blood vessels supplying the uterus to stop bleeding.

• Surgical Intervention: In rare and severe cases, surgical options like uterine compression sutures or, as a last resort, hysterectomy (removal of the uterus) may be necessary to save the mother's life.

How Mothers Can Take Care of Themselves During the Postpartum Period:

Being prepared and knowing what to do can make a significant difference. Here are some essential guidelines for new mothers and their support systems:

• Attend all prenatal appointments: This allows your healthcare provider to identify any potential risk factors for PPH early on.

• Communicate any concerns: If you feel unwell, dizzy, or notice unusually heavy bleeding after birth, inform your nurse or doctor immediately.

• Rest adequately: Your body needs time to heal and recover from childbirth. Overexertion can hinder recovery.

• Stay hydrated and eat nutritious meals: Proper nutrition supports healing and blood regeneration.

• Accept help: Don't hesitate to ask family and friends for support with household chores or baby care during your recovery.

• Don't ignore symptoms: Never assume heavy bleeding or feeling faint is "normal" after delivery. Seek medical attention promptly.

• Medication advice: Always consult your doctor before taking any medication postpartum.

• Seek emergency care: If you experience sudden, heavy bleeding or severe dizziness, go to the nearest emergency room without delay.

• Don't overexert yourself: Avoid heavy lifting or strenuous activities in the initial weeks postpartum.

• Schedule follow-up appointments: These are crucial for monitoring your recovery and overall well-being.

Our Obstetrics Services provide specialised maternal care, including timely diagnosis, emergency management, and support for postpartum complications

Conclusion

Understanding postpartum haemorrhage is vital for all new and expectant mothers. While PPH is a serious condition, timely recognition of symptoms and prompt medical intervention can significantly improve outcomes. By staying informed and proactive about your health, you can ensure a safer and healthier postpartum recovery. Always communicate any concerns with your healthcare provider and prioritise your well-being during this important phase of life.

If you are experiencing any concerning symptoms after childbirth, it's crucial to seek timely medical advice. For any postpartum concerns or warning signs, consult the experienced Obstetrics and Gynaecology team at Manipal Hospital, Goa, for timely and specialised care.