Postpartum hemorrhage (PPH) refers to excessive bleeding that occurs after childbirth, specifically within the first 24 hours, although it can also occur up to 12 weeks postpartum. It is defined as a loss of more than 500 milliliters of blood after a vaginal delivery or more than 1,000 milliliters following a cesarean section. PPH is a significant and potentially life-threatening complication, and prompt management is crucial to prevent severe consequences. The causes of PPH can be categorized into uterine, vaginal, and systemic factors. Uterine causes include uterine atony, where the uterus fails to contract effectively after delivery, leading to excessive bleeding. Other uterine issues such as retained placental fragments or placenta previa can also contribute. Vaginal causes might include tears or lacerations in the vaginal or cervical tissues. Systemic causes include clotting disorders or pre-existing conditions like gestational hypertension and preeclampsia, which can impair the body's ability to control bleeding.
Treatment for PPH involves immediate and aggressive management to control bleeding and stabilize the patient. Initial steps include administering uterotonics, medications that help the uterus contract, such as oxytocin, methylergometrine, or carboprost. Manual uterine compression and massage may be performed to stimulate uterine contraction. If bleeding is due to retained placental fragments, a thorough examination and possible surgical removal may be necessary. Blood transfusions might be required to replace lost blood and maintain hemodynamic stability. Addressing any underlying clotting disorders with appropriate treatment or medications is also essential. In cases where conventional treatments are insufficient, surgical interventions, such as uterine artery embolization or hysterectomy, might be needed. Effective prevention and management of PPH involve close monitoring during and after delivery, ensuring timely intervention to mitigate risks and ensure the health and safety of the mother.
