Causes of Postpartum Hemorrhage

Emobileclinic Trending Topic:Postpartum hemorrhage


Emobileclinic Specialist

Postpartum hemorrhage (PPH) is an obstetrical emergency. It is a major cause of maternal morbidity, and one of the top three causes of maternal mortality in both high and low per capita income countries, although the absolute risk of death from PPH is much lower in high income countries.

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All women lose some blood as the placenta separates from the uterus and immediately afterward. Normal bleeding just after childbirth is primarily from open blood vessels in the uterus, where the placenta was attached. (If you had an episiotomy or tear during birth, you may also bleed from that site until it’s stitched up.)

As the placenta begins to separate, these vessels bleed into the uterus. After the placenta is delivered, the uterus usually continues to contract, closing off these blood vessels.

Causes of PPH

  • uterine atony, distended bladder.

  • lacerations of the uterus, cervix, or vagina.

  • Tissue retained placenta or clots.

  • pre-existing or acquired coagulopathy.

  • Antepartum haemorrhage in this pregnancy.

  • Placenta praevia

  • Suspected or proven placental abruption

  • Multiple pregnancy

  • polyhydramnios or macrosomia.

  • Pre-eclampsia or pregnancy-induced

  • hypertension

  • Grand multiparity

  • retained placenta.

  • Maternal obesity. Body mass index >35 kg/

  • Existing uterine abnormalities.

  • Maternal age (40 years or older).

  • Maternal anaemia. Hb <9 g/dL

  • Factors relating to delivery:

  • Emergency caesarean section

  • Elective caesarean section especially if >3 repeat procedures.

  • Retained placenta

  • Mediolateral episiotomy

  • Induction of labour

  • Operative vaginal delivery, labour of >12 hours (2 x risk).

  • >4 kg baby

  • Symptoms:
  • continuous bleeding, which fails to stop after delivery of the placenta – third stage.

  • Blood loss of 1000 ml may be accompanied by clinically apparent shock, ie tachycardia

  • hypertension.

  • Haemolysis, elevated liver enzymes and Low platelets

    Prevention of Postpartum Hemorrhage

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  • Good prenatal nutrition and supplements.

  • The blood level of the pregnant woman must be checked and confirmed normal before setting for labour.

  • Placenta should be delivered gently and slowly.


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