The World Health Organization:
Postpartum Haemorrhage: is a loss of 500 ml or more from the genital tract after delivery. (PPH) Note: It is important to remember that a lower level of blood loss can cause the woman’s condition to deteriorate in certain circumstances. This will include the presence of anaemia or other medical conditions e.g. cardiac disease.
Primary postpartum haemorrhage (PPH) is excessive bleeding occurring within 24 hours of delivery.
- A woman can lose 500 ml of blood in one minute due to PPH.
- The average woman has 5 litres of blood in her circulation
- It takes 10 minutes for a woman to become exsanguinated, or to lose all her blood.
- Vital organs – kidneys – may stop functioning if a woman is severely shocked due to PPH.
- It is therefore easy to understand that the midwife must act quickly and efficiently in order to save life in cases of PPH.
CAUSES OF PRIMARY PPH:
– Atonic uterus (due for example to retained placenta or membranes)
-Genital trauma (includes both spontaneous and that caused by management or interference, e.g. instrumental delivery including caesarean section, episiotomy, “gishiri” cut)
– Coagulopathy/clotting failure (rare)
-Inversion of the uterus (rare)
The principles of managing PPH are:
The priorities in managing PPH include:
-Call for help (to assist in controlling bleeding).
-Make a rapid assessment of the woman’s condition.
-Find the cause of the bleeding stop the bleeding.
-Stabilize or resuscitate the woman.
-Prevent further bleeding.
These are priorities. This means they must be done first and before anything else.
In order to do those things which are most important, it is often necessary to:
-Change the order of what is usually done (e.g. it is usual to examine a woman from head to toe. If she is already having a postpartum haemorrhage when you are called to her, you need to quickly assess: color, pulse, blood pressure and level of consciousness, how much blood she has already lost and immediately feel her uterus to determine whether it is atonic haemorrhage. This can be done in a few seconds. Further detailed examination can be carried out later.
* Remember delay means death.
-Identify what must be done in order to save life.
Please Note: The woman will die unless:
-The bleeding is stopped.
-The woman is resuscitated or her condition is stabilized, this involves maintaining circulatory volume and managing shock.
Details Coming Soon on: Secondary Postpartum Haemorrhage – Which includes excessive bleeding occurring between 24 hours after delivery of the baby and 6 weeks postpartum.