Excessive bleeding after childbirth is called postpartum hemorrhage. This is a rare but serious complication of childbirth. Normally, there is some loss of blood after delivery but if this is more than 500 ml it constitutes an emergency as the mother's life could be at risk.
Major Cause of Maternal Mortality:
Postpartum hemorrhage (PPH) is one of the major causes of maternal mortality in both developed and under-developed countries. The loss of blood can cause a drop in blood pressure leading to shock and death. Shock is when the organs in the body don’t get enough blood and stop functioning. It is therefore extremely important to diagnose and treat the condition before it becomes critical.
Some Stats Regarding PPH:
The incidence of PPH is about 1 to 5% of all deliveries whether normal or surgical. The bleeding can occur immediately or within the first 24 hours of delivery. It is then called primary PPH. Bleeding can also occur from 24 hours up to 12 weeks after delivery and is known as secondary PPH.
Normally, during late pregnancy the blood flow to the uterus increases majorly. The bleeding during delivery helps in the expulsion of the baby and placenta. After delivery the uterus contracts and limits the amount of blood lost.
What happens in PPH:
In PPH there is heavy bleeding from the vagina that doesn’t slow or stop. The uterus either fails to contract (uterine atony) or fails to stop the cause of bleeding. Because of the continuous blood loss the blood pressure falls. There may be signs of shock such as blurred vision, chills, pallor of the face, cold and clammy skin, feeling weak, dizziness, faintness, nausea and vomiting. There may also be swelling and pain in the area between the vagina and the rectum.
Are some women more likely than others to have PPH?
Yes. A woman is more likely to have PPH if she has had it in a previous delivery. Certain medical conditions, and certain conditions that affect the uterus (womb), the placenta or blood can also predispose a woman to PPH.
What are the causes of this excessive bleeding after childbirth?
After delivery the uterus contracts and comes back to normal size slowly. However, if the contractions of the uterine muscles are imperfect the uterus fail to tighten fully and stop the bleeding after birth. This is known as uterine atony.
Uterine atony often occurs when and if the uterus has been stretched too much from growing twins or a large baby or from too much amniotic fluid. If a woman has delivered many babies, is elderly, or has been in labour for a long time too the uterus may fail to contract.
If the contractions have been too forceful during labour the uterus can turn inside out. This is called uterine inversion and is another cause of PPH.
The uterus may tear during labor from a scar in the uterus from a previous Caesarian section or from other kinds of surgery on the uterus leading to blood loss.
Be Wary of These Condition:
Certain conditions of the placenta such as early separation of the placenta from the uterus (placenta abruptio) or the placenta growing in deep into the wall of the uterus (placenta accreta), placenta praevia, where the placenta is situated low in the uterus, and retained placenta are other causes of continuous bleeding from the uterus.
Other Causes of PPH:
Other causes of PPH are anaemia and malnutrition, coagulation disorders, prolonged labour, retained pieces of placenta, cervical tears, vaginal or perineal tears, trauma to the pelvic area, and use of certain drugs such as nifedipine which predispose to haemorrhage.
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