POSTPARTUM HEMORRHAGE (PPH)
(Bleeding after Childbirth)

• Third Stage Haemorrhage:This is primary hemorrhage that occurrs after the delivery of the baby but before the expulsion of the placenta.

• True Primary Postpartum Hemorrhage: This is hemorrhage that occurs after the delivery of the placenta at any time within 24 hours of the birth of the baby. The majority of the cases of postpartum hemorrhages fall in this category.

Causes of Primary Postpartum Hemorrhage

• Atonic haemorrhage - 'Atonic' means lack of tone of the muscles or flabby muscles. Failure of the muscles of the uterus to contract properly after the placenta has been delivered is the commonest cause of postpartum hemorrhage. It accounts for about 80% of all cases.

  Causes of Atonic Postpartum Hemorrhage are:

  • Partial or complete retention of the placenta
  • When the muscles of the uterus are exhausted after prolonged labour.
  • Overdistension of the uterus as in cases of twin pregnancy or hydramnios
  • Tumours like fibroids preventing proper contraction of the uterine muscles
  • Repeated pregnancies can cause the uterine muscles to become lax and hemorrhage to occur in the later pregnancies.

• 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.