Causes Of PPH
It is normal for a woman to have bleeding after the birth of her baby. However, when a woman has too much or excessive bleeding after childbirth, this is called a postpartum hemorrhage (also known as PPH). PPH is an obstetric emergency where immediate interventions are needed to stop bleeding and save the mother.
The most common cause of PPH is uterine atony, when the muscles in the uterus (womb) do not contract completely following childbirth. Other causes of PPH can be due to retained placental tissue, tears of the vagina, cervix or uterus, and clotting disorders. Remember the “Four Ts”of PPH – Tone, Trauma, Tissue, Thrombin.
There are risk factors for PPH such as having a previous PPH, multiple pregnancy, anemia, a large baby, placenta abnormalities as well as prolonged labor, chorioamnionitis, placental abruption and a cesarean section.
PPH can happen to ANYBODY, and it is important to be knowledgeable about PPH.
A common diagnostic definition of PPH is blood loss of 500ml or more within 24 hours after birth. Severe PPH is when there is blood loss of 1000ml within the same time frame.
Other organizations have included signs and symptoms of hemodynamic instability (hypotension, tachycardia, altered mental status, etc.) to the above definition.
PPH can occur immediately after delivery, within 24 hours or even up to 12 weeks following childbirth.
PPH Statistics & Guidelines
Decreased access to quality care, limited resources, and lack of education and awareness of PPH continues to put mothers at risk of dying in childbirth. PPH occurs in every setting. It is important that ALL women have access to quality care which includes management of PPH.
Most maternal mortality due to hemorrhage is because of PPH.
In Northern Africa, 32% of maternal deaths are caused by PPH. In East Asia nearly 29% of maternal deaths are caused by PPH. In Latin and Central America, up to 50% of maternal deaths are due to PPH.