What Are The Causes And Types of Postpartum Hemorrhage?

Postpartum hemorrhage is one of the leading causes of maternal mortality. According to studies, postpartum bleeding alone causes more than 25% of maternal deaths caused during or after birth. There are different types of postpartum hemorrhage and it is necessary to know about them to be aware of the risks and signs of postpartum bleeding. This blog features the various types of postpartum hemorrhage and the four most common causes of postpartum bleeding.

What Is Postpartum Hemorrhage?

Postpartum hemorrhage is a serious complication of childbirth that results in the loss of a large amount of blood. It is a leading cause of maternal mortality. The amount of blood loss and the severity of postpartum hemorrhage depends on the stage of labour and delivery.

The different types of postpartum hemorrhage can be classified into mild, moderate, or severe, based on the amount of blood that is lost. The causes of postpartum hemorrhage vary. Women with a history of postpartum hemorrhage are at increased risk of postpartum hemorrhage in a subsequent delivery.

What Are The Types Of Postpartum Hemorrhage?

There are two types of postpartum hemorrhage: Primary postpartum haemorrhage and secondary postpartum haemorrhage.

Primary Postpartum Hemorrhage (PPH)

Postpartum hemorrhage is heavy bleeding that occurs after childbirth. Primary postpartum hemorrhage is excessive bleeding after the placenta separates from the uterine wall. All women experience uterine contraction after the delivery of the baby. However, with primary postpartum hemorrhage, the bleeding is excessive and occurs between the time of delivery and 24 hours after delivery. According to studies, primary postpartum hemorrhage occurs in around 1%-6% of all deliveries.

Secondary Postpartum Hemorrhage (SPH)

Secondary postpartum hemorrhage is bleeding that occurs from 24 hours to 6 weeks into the postpartum period. The occurrence of secondary postpartum hemorrhage is way less than primary postpartum hemorrhage. However, it still affects 0.2%-0.8% of all the deliveries. It is one of the most common causes of hospital readmission after delivery. Secondary postpartum hemorrhage can affect women who have had a previous low transverse uterine incision due to uterine atony, active vaginal bleeding, retained placental fragments, and lacerations of the cervix.

What Are The 4 Most Common Causes Of Postpartum Hemorrhage?

Four Ts can be used to identify the cause of postpartum hemorrhage: tone, trauma, tissue, and thrombin. Each of these has its own set of signs and symptoms that can help to pinpoint the underlying cause.

1. Uterine Atony (Tone)

Uterine atony is the most common cause of postpartum haemorrhage. The tone here refers to the tone of the uterine muscles. Uterine atony occurs when the muscles of the uterus fail to contract properly after childbirth. This can cause the blood vessels in the uterus to leak, resulting in heavy bleeding. If the cause is tone, the uterus may need to be stimulated with medication or a shot of Pitocin.

2. Laceration, Hematoma, Inversion, Rupture (Trauma)

This can occur during childbirth if the baby is large or the birth is particularly difficult. It can also happen if the placenta is not delivered properly. In rare cases, it can also be caused by medical interventions such as C-sections. Trauma to the uterine walls or cervix can also cause heavy bleeding. In case the cause of postpartum bleeding is trauma, the wounds may need to be repaired surgically.

3. Retained Tissue Or Invasive Placenta (Tissue)

If the placenta is not correctly detached from the uterine wall, it can lead to postpartum haemorrhage. This is because the blood vessels in the placenta are still open and bleeding. If the cause of postpartum bleeding is tissue, the placenta may need to be removed manually.

4. Coagulopathy (Thrombin)

Coagulopathy is the abnormality during blood clotting which can be caused by several factors including both hereditary and acquired factors. Thrombin is a clotting factor that is essential for proper blood clotting. If there is a deficiency of thrombin, it can lead to heavy bleeding. If the cause of haemorrhage is thrombin, blood transfusions or medication may be necessary.

To sum up, different types of postpartum hemorrhage require different kinds of treatments. Thus, identifying the cause of postpartum hemorrhage is essential to provide the appropriate treatment. New mothers must also focus on their postpartum care to ensure their health and safety.