PPH occurs when a woman loses more than 500mls of blood in the first 24hours after delivery of her baby. If the bleeding is excessive after the first day from the birth then it is a classified as a secondary postpartum haemorrhage.
When the placenta detaches from the uterine wall after birth a large raw area with blood vessels in the uterine muscle are revealed. With effective contraction of the uterus the blood loss is restricted. Excessive blood loss (PPH) can occur when the uterus does not contract and is floppy. This is the most common cause of postpartum haemorrhage.
If placental fragments are left inside the uterus this can also cause bleeding or over time infection. If there is a tear in the uterus, cervix, vagina or perineal area, this may also cause a postpartum haemorrhage. Rarely a clotting disorder may result in a postpartum haemorrhage.
One of the most effective ways to prevent a postpartum haemorrhage is the administration of Syntocinon with the birth of the baby. This results in a well contracted uterus. The placenta is then delivered with gentle traction on the umbilical cord. If, despite these measures the blood loss is still excessive, the fundus or top of the uterus is massaged to encourage it to contract. An IV line will be inserted for fluids and further Syntocinon. A urinary catheter is necessary to ensure the bladder is empty and inspection of the vagina and cervix is required to rule out tears.
If further bleeding continues, then the mother will usually require examination under anaesthetic in an operating theatre. The uterine cavity will be examined to remove any placental fragments and further medication to contract the uterus will be given. In very rare/severe cases, surgery to contract the uterus or hysterectomy may be required.
If the bleeding is a secondary postpartum haemorrhage, then an infection of the lining of the uterus (endometritis) is a common cause and will respond to antibiotics. An ultrasound to exclude retained placental fragments may also be ordered.
Most women will have a normal blood loss lasting for approximately 1 month after delivery. This can fluctuate, but if it is heavy and concerning you should contact your doctor or midwife.
