Postpartum Hemorrhage- whether after a natural vaginal delivery or a cesarean, is one of the major postpartum complications, leading to maternal death across the world.
A natural or a cesarean delivery can cause a blood loss of around 500 – 1000ml. Postpartum hemorrhage is defined as a loss of more than 500ml of blood in case of a natural delivery or more than 1L of blood in case of a cesarean and may cause vaginal bleeding or internal bleeding into the abdominal cavity. The signs may include hypovolemia, dizziness, fainting or tachycardia. It usually starts in the first 24 hours after delivery, though it may also occur after that and can last for around 4-6 weeks, before being diagnosed and treated.
It Is Caused Due To Uterine Trauma And Some Other Reasons, Medically Referred To As The ‘Five Ts’, As Mentioned Below –
Tone – Uterine loss of tone, which implies inability of the uterus to contract after delivery causing heavy bleeding.
Trauma – trauma from the delivery, especially due to a large baby or multiple babies, cervical laceration or when accompanied by additional surgeries may cause the major tissues to tear and cause heavy bleeding.
Tissue – retention of any tissue from the placenta or even the fetus, or infection of the same, can cause heavy bleeding. Other conditions like placenta previa or placental abruption can also contribute to it.
Thrombin – in case after delivery, the blood fails to clot (medically diagnosed as coagulopathy), it may lead to a continuous blood flow.
Traction – in the case of uterine inversion leading to blood loss.
Some of the standard intervention protocols used include, administering oxytocin or external uterotonics, performing uterine (fundal) massage, blood transfusion, performing laparotomy with uterine compression stitches and/or a hysterectomy.
Studies show that, active management during the final stages of labour, and during pregnancy, can help mitigate the problem. Sometimes, the pregnant mother is given certain medications prior to delivery, so as to ensure the placenta comes out quickly.
Some Measures Used To Prevent It From Occurring Include –
Encouraging the mother to breastfeed the baby, thereby causing release of natural oxytocin in the mother.
Uterine massage, which helps to ease blood clots.
Emptying of bladder, naturally or by intervention helps lessen the chances of hemorrhage.
Taking care to prevent infections.
Since it can occur after delivery too, some signs to check include rate at which the absorbent pads need to be changed, big clots in the discharge along with foul odour, or any dizziness.
If Not Taken Care Of, It May Lead To –
Hypovolemic shock leading to organ failures like renal (kidney) failure, stroke or heart attack and even death.
Acute blood loss also affects the pituitary gland resulting in problems like brain tissue death, inability to breastfeed, amenorrhea and other hormonal problems etc.
It can also lead to edema (swelling) of the extremities as well as pulmonary edema which can be life threatening.
