Written by : Dr.M.D.Mazumdar, MD
Postpartum haemorrhage is defined as excessive bleeding occurring at any time from the birth of the baby upto 6 weeks after delivery. The blood loss has to be greater than 500 ml of blood following vaginal delivery, or 1000 ml of blood following cesarean section to be labelled as postpartum hemorrhage. This amount is usually sufficient to affect the general condition of the woman.
There are two clinical types of postpartum hemorrhage:
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Causes of Atonic Postpartum Hemorrhage are:
Traumatic Haemorrhage : Bleeding can occur from maternal injuries like cervical, vaginal or perineal tears. While minor tears cause only a minimal bleeding which is easily controlled, deep tears may need to be examined and repaired under anesthesia.
Mixed PPH: Postpartum hemorrhage is frequently a mixture of both atonic as well as traumatic hemorrhage. Many of the factors that contribute to the laxity of the uterine muscles are also factors that contribute to injury of the birth canal.
Blood Coagulopathy: Blood coagulopathies like decreased level of platelets in the blood (thrombocytopenia), Factor V Leiden, Von Willebrand's disease are conditions that decrease the ability of the blood to form clots. This can lead to severe hemorrhage.
The main principles of management are:
(a) Prevention of further blood loss.
(b) Restoration of proper blood volume.
(c) Repair of the injured tissues.
(D) Stimulating contraction of the uterine muscles.
Treatment depends on whether the bleeding has occured before the placenta has separated from the uterine wall and been delivered or whether the placenta is still in place inside the uterus (Retained Placenta).
Retained Placenta:
Where the placenta has been delivered but bleeding is still present:
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