High Mortality Rate Due to Severe Loss of Blood after Childbirth

Emobileclinic Trending Topic: Postpartum Haemorrhage (PPH)

This is defined as excessive bleeding from the genital tract after delivery or childbirth. It is further divided into; primary (which occurs immediately after childbirth and Secondary (which occurs after 24 hours of delivery) According to WHO primary postpartum haemorrahage is an excessive bleeding of 500ml in the first 24 hours following delivery. Maternal mortality from postpartum haemorrhage is much greater problem in developing countries. WHO estimated about 500,000 death yearly of which 98% occur in developing countries.

The main causes of primary PPH are failure of the uterus to contract effectively, retention of placenta and membranes in the uterus and trauma to the genital tract. Very rare causes include placenta accrete, uterine inversion and coagulation disorder. Bleeding from the genital tract may be encountered following an episiotomy and perineal tear but most troublesome cases occur after operation.

Possible causes are multiple pregnancy, induction of labour, primiparity, grand multiparity, antenatal anaemia, previous third stage complications, prolonged labour have traditionally been linked with higher incidence of postpartum haemorrhage. Maternal age of 35 years above, low parity (having none or one previous delivery), antenatal hospitalization mainly for anaemia, antepartum haemorrahage and pregnancy-induced hypertension are also significant predictors of postpartum haemorrhage when no adjustment for confounding with intrapartum variables are found.

Management of postpartum haemorrhage include blood transfusion, fluid replacement, regular monitoring of pulse rate, blood pressure, CVP, blood gases, acid-base status and urine output. In most cases the source of bleeding has to be arrested while vascular resuscitation is being carried out.

There has been cases of several maternal deaths few years ago due to woman refusal to accept a blood transfusion based on religious beliefs. For example a group of Christians believe that the Bible forbids the consumption of blood or blood products. This usually led to obstetric haemorhage in women who refuse blood transfusion.

It is important that any women who refuse to accept blood transfusion states her objectives and reasons.

• The principle management of haemorrhage in these women is to avoid delay and the threshold for intervention should be lower than in other pregnant women.

• Extra vigilance is however needed to quantify any abnormal bleeding as accurately as possible and to detect complications such as clotting abnormalities as promptly as possible. In cases of abnormal bleeding, the consultant anesthetist and haematogist should be notified.

• Dextran should be avoided for fluid replacement because of the possibility of interaction with haemostasis.

• Vitamin K should be administered intervenously in cases of severe bleeding.
  
  
  

• The woman should however be informed of all unfolding events and must not be pressurized to accept blood transfusion because it has legal implication

• Hysterectomy is usually the last resort in cases of severe complications.

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