Postpartum Hemorrhage or PPH is a serious concern and the main cause of maternal mortality and morbidity across the world. PPH is the excessive bleeding after childbirth. In a normal or vaginal delivery if there is a blood loss of more than 500ml and in case of a C-Section if there is a blood loss of more than 1000ml then PPH is said to have occurred. If bleeding occurs within the first 24 hours of delivery it is called Primary PPH; whereas any excessive bleeding that occurs between 24 hours and 6 weeks after delivery is termed as Secondary PPH. Postpartum hemorrhage accounts to about 30% of maternal deaths.
The most common cause of PPH is uterine atony which is impaired uterine contraction after birth, which occurs in most of the cases. Some other common factors that might lead to PPH are: –
- High Blood Pressure during pregnancy
- Twin Pregnancy
- Hydramnios – a condition in which excess amniotic fluid accumulates during pregnancy
- Prolonged Labor
- Retained Placenta or Clots
- If any previous history of PPH
In India, Anemia in women during pregnancy is the major cause that leads to uterine atony. For treating anemia, women should take their prenatal vitamins which contain iron and folic acid as advised by their doctor on a regular basis. They should also include foods like red meat, eggs, dark leafy vegetables like spinach, broccoli etc., lentils and nuts in their diet as these are rich in iron and Vitamin C rich foods.
Treatment of PPH is crucial in the first hour which is termed as “The Golden Hour” – where resuscitation begins to arrest the bleeding. A woman can bleed to death in 2 hours or less. If she bleeds continuously she may go into shock which may be irreversible even resulting in the death of the patient. The initial treatment includes fluid replacement with intravenous fluids. The patients’ feet are elevated and oxygen is given. Blood investigation is to be done while monitoring her pulse rate, blood pressure and urine output and uterine massaging are done. Also, transfuse blood products during this time. If none of the medical management works then proceed to surgical management.
There have been certain low-cost treatment procedures that have been implemented in developing countries to treat PPH and have been quite effective. Some of these are: –
- The Non-pneumatic Anti-shock Garment (NASG) is a low technology first-aid device that can be placed around the lower body of a woman who has gone into shock. This garment decreases blood loss, and helps the woman to recover from the shock and will keep her alive while shifting her to a healthcare
- Try balloon tamponade using Bakri Balloon which is an intra-uterine device to reduce or control blood loss. The device consists of a silicon balloon connected to a catheter of the same material. The collapsed balloon is inserted into the uterine cavity, and when it is inflated with liquid it conforms to the shape of the cavity and stops the bleeding.
- Condom Tamponade – In this case, the condom is used as a tamponade for intrauterine pressure to stop massive postpartum hemorrhage (PPH). This condom tamponade can control PPH quickly and effectively. It is simple to use, inexpensive, and safe.
In developing countries where PPH remains a primary cause of maternal mortality, any healthcare provider involved in delivery may use these above procedures for controlling massive PPH to save the lives of patients.
About the Author
Dr. Sheela V Mane is an eminent Gynecologist and Obstetrician from Bangalore with 35 plus years of expertise in this field. Currently, Dr. Sheela practices as a consultant at Anugraha Nursing Home and is an active member at Association of Gynecologic Oncologists of India – AGOI, Federation of Obstetric and Gynecological Societies of India (FOGSI), Indian Medical Association (IMA) and Indian Menopause Society (IMS)