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Why it’s important to know about Postpartum Haemorrhage?

Every year about 14 million women around the world suffer from postpartum haemorrhage – World Health Organisation

What is postpartum haemorrhage?

Postpartum Haemorrhage is defined as blood loss of 500 ml or more within 24 hours after birth. Severe bleeding is considered as one of the largest direct causes of maternal deaths. When mothers die in childbirth, the newborns run a risk of dying within 30 days.

What are the causes?

When a baby is delivered, the uterus contracts (tightening of uterine muscles) to expel the placenta. When the placenta is delivered, the contractions help in compressing the blood vessels in the area where the placenta was attached. When the uterus doesn’t contract strongly (uterine atony), the vessels bleed profusely leading to a haemorrhage.

Also increasing the risks for postpartum haemorrhage are:

  • Placental abruption – when the placenta detaches early from the uterus.

  • Placenta previa – this obstetric complication occurs when the placenta covers the cervix partially or totally.

  • Overdistended uterus.

  • Gestational hypertension or preeclampsia.

  • Prolonged labor, infection, obesity, use of medications to induce labor, use of medications to stop contractions, and deliveries that are assisted by forceps or vacuum are some of the other key reasons why postpartum haemorrhage occur, states Stanford Children’s Health.

How to manage and prevent?

As published by WHO,

“1. The use of uterotonics for the prevention of PPH during the third stage of labour is recommended for all births. (Strong recommendation, moderate-quality evidence)

2. Oxytocin (10 IU, IV/IM) is the recommended uterotonic drug for the prevention of PPH. (Strong recommendation, moderate-quality evidence)

3. In settings where oxytocin is unavailable, the use of other injectable uterotonics (if appropriate ergometrine/methylergometrine or the fixed drug combination of oxytocin and ergometrine) or oral misoprostol (600 µg) is recommended. (Strong recommendation, moderatequality evidence)

4. In settings where skilled birth attendants are not present and oxytocin is unavailable, the administration of misoprostol (600 µg PO) by community health care workers and lay health workers is recommended for the prevention of PPH. (Strong recommendation, moderatequality evidence)

5. In settings where skilled birth attendants are available, CCT is recommended for vaginal births if the care provider and the parturient woman regard a small reduction in blood loss and a small reduction in the duration of the third stage of labour as important (Weak recommendation, high-quality evidence)

6. In settings where skilled birth attendants are unavailable, CCT is not recommended. (Strong recommendation, moderate-quality evidence)

7. Late cord clamping (performed after 1 to 3 minutes after birth) is recommended for all births while initiating simultaneous essential newborn care. (Strong recommendation, moderatequality evidence)

8. Early cord clamping (<1minute after birth) is not recommended unless the neonate is asphyxiated and needs to be moved immediately for resuscitation.

9. Sustained uterine massage is not recommended as an intervention to prevent PPH in women who have received prophylactic oxytocin.

10. Postpartum abdominal uterine tonus assessment for early identification of uterine atony is recommended for all women.

11. Oxytocin (IV or IM) is the recommended uterotonic drug for the prevention of PPH in caesarean section. (Strong recommendation, moderate-quality evidence)

12. Controlled cord traction is the recommended method for removal of the placenta in caesarean section. (Strong recommendation, moderate-quality evidence)”

However, these recommendations need to be taken up with your doctor in order to assess what suits your pregnancy best.

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