Postpartum haemorrhage occurs when a woman experiences heavy blood loss of more than 500ml after vaginal delivery or more than 1000ml after Caesarean delivery. It is still a primary cause of severe maternal morbidity and mortality. Women living in lower-income countries are at higher risk of death due to postpartum haemorrhage. In this article Dr. Mahesh Gupta, High-risk Obstetric Consultant at Indus High Risk Pregnancy Hospital, Ahmedabad, explains all about postpartum haemorrhage and why awareness regarding this condition needs to be amplified.
There are two different types of postpartum haemorrhage; they are
- 1) Primary/early, which occurs within 24 hours of birth; and
- 2) Secondary/delayed, which occurs after 24 hours of birth, and can take up to 12 weeks.
The World Health Organization (WHO), International Federation of Gynecologists and Obstetricians (FIGO) and American College of Obstetricians and Gynecologists (ACOG) developed a set of evidence-based guidelines for the prevention and management of postpartum haemorrhage. In spite of all efforts, there is still a lack of adherence in postpartum haemorrhage management. Despite the difficulty of recognising postpartum haemorrhage, timely recognition, early intervention, appropriate resources, and appropriate response are required to prevent death.
What causes Postpartum Haemorrhage?
Postpartum haemorrhage is a serious but uncommon disorder. The placenta is normally pushed out of the uterus after the baby is delivered. These contractions help put pressure on the bleeding vessels in the area where the placenta was attached after it was delivered. If the contractions are not strong enough, the vessels bleed more. The most common cause of postpartum haemorrhage is uterine atony, which occurs when the uterus loses its ability to contract and the woman continues to bleed profusely. The placenta can also be retained in the uterine wall, which can cause severe bleeding.
A slightly reassuring fact is that the mortality rate with postpartum haemorrhage has fallen gradually since the 1980s and currently accounts for about 10% of all maternal deaths. Credit goes to transfusions, peripartum hysterectomy, and standard bundles of care. Controlling bleeding within the first-hour post-diagnosis is termed the “Golden Hour” and is essential to avoid serious complications. The key to prevention is early detection of postpartum haemorrhage. This can be done by regular monitoring of the blood loss during labour and delivery. It is essential to understand that giving birth is a crucial situation for the mother, and any delivery can turn into a complicated case at any time, whether just before or after delivery of the baby.
There are various surgical and non-surgical treatments available for the treatment of postpartum haemorrhage that are categorised by the World Health Organisation. One of the surgical treatments is the COMOC-MG (which translates to "compression of myometrium" and "occlusion of the uterine artery") technique, which is a novel approach for the treatment of postpartum haemorrhage. COMOC-MG is a type of postpartum haemorrhage surgical procedure that can be performed when there is severe bleeding during childbirth. Compared to other methods, COMOC-MG requires less equipment and is relatively simple, safe, and highly effective in practice. On one side of the suture, there is a straight needle, and on the other, there is a curved needle with a free end. With a single puncture in the uterus, both compression of myometrium, and occlusion of the uterine artery can be achieved.
Know your risks ahead of time
Anaemia is very common in India. Iron deficiency anaemia (IDA) is the most common form of anaemia in pregnancy. It is estimated to affect up to 50% of pregnant Indian women. If the haemoglobin levels are normal at the time of delivery, the body can withstand a significant amount of loss without harm. So, in addition to the supplements prescribed by the doctor, it is necessary to take a diet rich in iron and protein.
Good nutrition is the key. During pregnancy, it is necessary to pay special attention to your diet. It is important to have a balanced diet, which is rich in protein, iron, and calcium.
When should you call your healthcare provider?
Postpartum haemorrhage symptoms may have close resemblance with other medical conditions. Always consult your healthcare provider for a diagnosis. Discuss with your doctor the symptoms of postpartum haemorrhage and what to look out for. Early intervention can reduce blood loss. The majority of postpartum haemorrhage occur during or shortly after delivery. However, you may bleed profusely after leaving the hospital. If this occurs, contact your healthcare provider right away if you have any of the following symptoms:
- You pass large blood clots or have vaginal bleeding that requires a new sanitary pad every hour.
- Lightheadedness, weakness, dizziness, or fainting (syncope)
- New or worsening abdominal pain
- Extreme exhaustion (fatigue)
- A rapid heartbeat (tachycardia), palpitations
- Blurred vision, excessive/abnormal sweating (diaphoresis)
Although the phrase ‘during pregnancy’ could be used in this context, the phrase ‘at any time’ implies that the relevant time period is not limited to just before and after delivery of the baby. In many situations, postpartum haemorrhage recovery will be necessary to maintain your health. The postpartum period is a time of great change, and it is important to be aware of the changes that are taking place in your body and mind. Psychological counselling, a healthy diet, and family support may all be necessary.
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