Introduction:

Childbirth is a joyous occasion, but it can also come with potential complications.
Postpartum hemorrhage (PPH) is one such concern, referring to excessive bleeding after
delivery. While some blood loss is expected following birth, PPH can be serious and requires
prompt medical attention.

Definition:

Postpartum hemorrhage is defined as significant blood loss following childbirth. The exact
amount defining "significant" can vary depending on the delivery type (vaginal or cesarean)
and individual circumstances. Still, it generally refers to losing more than 1,000 mL of blood
after a vaginal delivery or 1,500 mL after a cesarean section. Additionally, any amount of
bleeding accompanied by signs of hypovolemia (low blood volume) can be considered PPH.

Types:

There are two main types of postpartum hemorrhage:

 Primary PPH: This occurs within the first 24 hours after delivery.
 Secondary PPH: This occurs between 24 hours and 12 weeks postpartum.

Risk Factors:

Several factors can increase a woman's risk of PPH, including:

 Previous history of PPH

 Multiple pregnancies
 Uterine fibroids
 Placenta previa (placenta implanted low in the uterus)
 Placenta accreta (placenta adheres abnormally to the uterine wall)
 Preeclampsia (high blood pressure during pregnancy)
 Uterine rupture
 Prolonged labor
 Large baby size
 Precipitous labor (very rapid delivery)

Causes:

The most common causes of PPH include:

 Uterine atony (failure of the uterus to contract and clamp down after delivery)
 Retained placental tissue (pieces of placenta remaining in the uterus)
 Lacerations (tears in the cervix or vagina)
 Uterine inversion (uterus turning inside out)
 Coagulopathy (disorders affecting blood clotting)

Clinical Manifestations:
Symptoms of PPH can include:

 Heavy vaginal bleeding that soaks through pads quickly

 Rapid heart rate
 Dizziness or feeling faint
 Shortness of breath
 Pale skin
 Feeling cold and clammy
 Excessive thirst
 Decreased urine output

Diagnosis:

Diagnosis of PPH involves a physical examination, assessment of blood loss, and potentially
blood tests to check for anemia or clotting problems. In some cases, ultrasound imaging
may be used to visualize the uterus and placenta.

Prevention:

Several measures can help reduce the risk of PPH, including:

 Active management of the third stage of labor (after delivery of the baby) with
medications to promote uterine contraction
 Careful monitoring of blood loss after delivery
 Uterine massage to stimulate contraction
 Identifying women with risk factors and taking appropriate precautions

Management:

Treatment for PPH depends on the severity and cause. It may involve:

 Medications to promote uterine contractions

 Manual massage of the uterus
 Packing the vagina with gauze to apply pressure
 Blood transfusion
 Surgical intervention in severe cases

Complications:

Untreated PPH can lead to serious complications, including:

 Shock
 Anemia
 Organ failure
 Death (in rare cases)