While pregnancy is a special time in a woman’s life, it can be particularly challenging health-wise, too. While most people focus on the nine months of gestation followed by the delivery of the baby, for a mother, her postpartum health is crucial, too. Unfortunately, many women suffer from excessive blood loss post-delivery, which is known as postpartum hemorrhage (PPH).
According to Dr (Lt Col) Leena N Sreedhar, HOD and consultant – obstetrics and gynaecology, HCMCT Manipal Hospitals, Dwarka, PPH still remains the biggest contributor to maternal mortality. “Thousands of women all over the country lose their lives to PPH, which is a manageable condition if acted upon in a timely manner,” the doctor states.
What is postpartum hemorrhage and how is it managed?
The doctor explains that postpartum hemorrhage is a pregnancy-related complication, defined as the loss of >500ml blood during vaginal birth; severe postpartum hemorrhage is the loss of >1000 ml during cesarean birth.
“The most common cause is uterine atony, but other causes include genital tract trauma (lacerations of the vagina or cervical region), uterine rupture, retained placental tissue, or maternal coagulation problems. Grand multiparity and multiple gestation are linked to a higher risk of bleeding after birth, even though the majority of women who develop PPH problems have no known clinical history or risk factors,” says Dr Leena, adding that pre-existing anemia can make PPH worse and even a modest amount of blood loss can have negative clinical effects.
PPH during pregnancy can be complicated, the expert warns. “The health condition of the expecting mother can undoubtedly be a challenge. With placenta previa, the placenta can cover more uterine space than normal for a healthy delivery, hence, the pregnancy can be at high risk. In case of a vaginal birth or normal delivery, the mother could easily suffer multiple complications.”
The doctor states that postpartum hemorrhage can be avoided with “timely intervention of a multidisciplinary team of critical care obstetrics”.
“This condition can often go undiagnosed and may be confused with other issues. The management requires proactive observation of obstetrics and critical care teams for early signs and active support from blood banks, as the body loses blood rapidly and transfusion is vital to prevent loss of life,” the doctor states, adding that to save the woman from dying of PPH, measures like “balloon tamponade, brace sutures to closely tie muscle wall, stepwise devascularisation and finally, a timely hysterectomy” can be considered.
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