Did you also bleed a lot after having a baby? Let's talk about Postpartum Hemorrhage (PPH)

It's normal to bleed a little after giving birth. But what if you bleed a lot more than you thought? It can be really scary and dangerous. This is what we call postpartum hemorrhage (PPH) . This is not a joke, it's a condition that requires immediate medical attention.

What is postpartum hemorrhage (PPH)? Let's understand exactly?

Simply put, postpartum hemorrhage (PPH) is heavy bleeding after delivery. This usually happens within 24 hours of delivery. We call it 'Primary PPH' . But sometimes, bleeding can occur a few days, a few weeks, or even up to 12 weeks after delivery. This is called 'Secondary or Late PPH' .

What happens in this is that a lot of blood is lost from your body at once. When this happens, your blood pressure can drop suddenly. What happens then? The amount of blood going to the heart, brain, and other vital organs decreases. This is called hypovolemic shock . This can be life-threatening. Therefore, doctors and nurses need to stop this bleeding quickly.

Remember, if you feel like you're bleeding a lot after having a baby, it's scary. But the most important thing is not to panic, and to tell your doctor or midwife right away. If recognized early and treated quickly, you can often make a full recovery.

How much blood does PPH cause?

Usually,

• Whether you have a vaginal delivery or a C-section, if you lose more than one liter (1000ml) of blood,
• Or, if there is a significant change in your heart rate and blood pressure along with the amount of blood lost, and you are showing signs of a lot of blood loss, it is considered PPH.

This condition can occur in between 1 and 5 out of 100 births. That's between 1% and 5%. But with prompt treatment, most of the time it's not life-threatening.

How do I know if I have PPH? What are the symptoms?

The main symptom of PPH is persistent, heavy vaginal bleeding after delivery. Sometimes , blood clots larger than a golf ball can pass through. If this happens, it could be a sign of a problem.

Other symptoms are:

• Symptoms of low blood pressure: dizziness, blurred vision, and fainting.
• Increased heart rate (Tachycardia).
• Decreased red blood cell count (decreased hematocrit levels).
• Pale or clammy skin, feeling like you're breaking out in a cold sweat.
• Pain and swelling in the vaginal area or perineal area (this occurs when blood collects outside of a vein)

If you experience any of these unusual symptoms after giving birth, tell your healthcare provider right away . Sometimes, PPH symptoms can persist even after you go home from the hospital. If this happens, don't panic and see your doctor right away.

Why does PPH happen? What are the causes?

There are several causes of PPH.

You know, when your baby is in the womb, the placenta attaches to the wall of your uterus and provides the baby with food and oxygen. After your baby is born, your uterus continues to contract and expel the placenta. These contractions cause the blood vessels where the placenta was attached to to tighten and stop the bleeding. But sometimes, if these contractions aren't strong enough , the bleeding won't stop. This is the cause of 80% of PPH.

Also, PPH can occur if parts of the placenta remain in the uterine wall, or if the organs of your reproductive system (vagina, cervix, uterus) are damaged during delivery.

PPH most often occurs between 30 and 60 minutes after the baby is born.

The "Four Ts" that affect PPH

There are four main causes of PPH, called the "Four Ts".

1. Tone (condition of the uterus - Uterine Atony): This is the most common cause . Uterine atony is when the uterus does not contract properly after delivery, but becomes soft and weak. Then the blood vessels where the placenta was do not tighten, and bleeding continues.

2. Trauma: During childbirth, bleeding can occur due to injuries to the vagina, cervix, uterus, or perineum. Sometimes this blood can pool inside the injured tissue and continue to bleed for hours or days after delivery.

3. Tissue (Retained placental tissue): If the placenta does not completely separate from the uterine wall, the remaining tissue can cause bleeding. This can be due to an abnormality in the placenta, or it can be a normal placenta.

4. Thrombin (blood clotting problems): If you have a coagulation disorder, or if you had a condition that affected blood clotting during pregnancy, even a small amount of bleeding can be a big problem.

Who is at higher risk of PPH?

In fact, PPH can happen to anyone who is having a baby. Although there are many risk factors for PPH, about 40% of PPH cases occur without any risk factors . Therefore, doctors may not be able to completely prevent PPH. However, knowing what these risk factors are before giving birth can help reduce the risk of heavy bleeding.

Placental conditions

The risk of PPH is higher if you have any of the following conditions related to the placenta:

• (Placenta previa) (placenta is located low in the uterus)
• (Placental abruption )
• (Placenta accreta) (Placenta firmly attached to the uterine wall)

Conditions related to childbirth or labor

The risk of PPH may increase if the following things happen during childbirth:

• If general anesthesia has been given.
• If you have been given medication (tocolytics) to stop uterine contractions.
• If the pain is prolonged or if the medicine used to induce uterine contractions (Oxytocin / Pitocin®) is given too much for too long.
• Having a baby early (less than three hours after the onset of labor).
• If forceps or a vacuum were used during a normal delivery.
• If there are large lacerations in the vagina.
• If the baby was delivered by cesarean section .

Other health conditions

Other health conditions can also increase the risk of PPH, such as:

• Blood clotting diseases, for example (von Willebrand disease) .
• If you have taken the medicine (Magnesium sulfate) to treat severe preeclampsia .
• Pregnancy conditions that affect blood clotting factors or platelets, for example: (HELLP syndrome) , (gestational thrombocytopenia) .
• An infection of the amniotic sac (Chorioamnionitis) .
• Obesity.
• Advanced maternal age.

Also, the risk of PPH is higher if the uterus is overdistended . This can happen:

• If you have had five or more previous births.
• In multiple births, such as twins and triplets.
• If you have a large baby (macrosomia) .
• If there is too much amniotic fluid (polyhydramnios) .

What are the possible side effects of PPH?

When you lose too much blood, you may experience things like an increased heart rate, increased breathing rate, and decreased blood circulation. These symptoms can reduce the amount of blood flowing to organs like the liver, brain, heart, and kidneys, leading to shock . Shock is when the organs do not get enough blood. This can lead to organ failure or even death.

How to recognize PPH after a cesarean section (C-section)?

In most cases, PPH symptoms after a C-section are the same as during a normal delivery. Some of the symptoms include:

• Increased heart rate.
• Cold hands and feet, feeling clammy.
• Difficulty breathing.
• Swelling, bruising, or pain elsewhere in the abdomen, especially at the site of the surgical wound.
• Excessive vaginal bleeding and passing large blood clots.

How do doctors diagnose PPH?

Doctors diagnose PPH through visual and physical examinations. Lab tests and a careful review of your health history are also important to assess the risk and impact of PPH.

PPH is diagnosed mainly by the amount of blood you have lost. The amount of blood lost is usually estimated by counting or weighing the pads or sponges that were soaked with blood when the baby was delivered.

If you suspect PPH, you can use these things to further test yourself:

• Continue to monitor your pulse rate and blood pressure .
• Blood tests that measure the amount of red blood cells in the blood (hematocrit) and blood clotting factors.
• A pelvic exam that examines the vagina, cervix, and uterus.
• An ultrasound scan takes a detailed image of the uterus.

How is PPH treated?

Doctors often treat PPH as an emergency. The main goal of treatment is to stop the bleeding as quickly as possible.

Depending on the cause of your bleeding and the severity of the bleeding, your doctor may recommend one or more of these treatments:

• Uterine massage to contract the muscles of the uterus.
• Giving medication that stimulates uterine contractions.
• Removing retained placental tissue, either manually or by some other method.
• Repairing tears in the vagina, cervix, and uterus.
• Inserting a device, such as a catheter or balloon, to apply pressure to the uterine walls and stop bleeding.
• Procedures that stop the blood supply to the uterus.
• You need a blood transfusion .
• Giving fluids through a vein (intravenous - IV fluids) , which means things like saline.
• Giving supplemental oxygen through a mask.
• Prescribing iron supplements .

Very rarely, or if other methods fail, the doctor may perform a laparotomy (a surgery to open the abdomen and find the source of the bleeding) or a hysterectomy (removal of the uterus).

How long does it take to recover from this PPH condition?

Recovery time varies from person to person. It depends on how much blood you lost and how your doctors treated you. It's important to take good care of yourself in the first few days after your baby is born – eat well, drink plenty of water, and get as much rest as possible . Your doctor may also recommend taking iron supplements to treat anemia.

Can PPH be prevented? Can I have a baby again?

The best way for doctors to prevent PPH is to identify those at higher risk of PPH before delivery. You can help by sharing your full medical history with your doctor and notifying them if you have any symptoms of PPH after you have your baby.

It's usually safe to have another baby. However, talk to your doctor about your risk of PPH in your next birth. Even if your risk is slightly higher than normal, it's still likely to be low. Your doctor can look at your risk factors and decide if you need to take any special precautions in your next birth.

How do you take care of yourself after a PPH?

It can be hard to take care of yourself while you're taking care of your newborn. But, if you take time to rest and take good care of yourself, you'll be able to recover faster. Your well-being is very important.

Here are some things that can help you:

• Rest: Your body needs time to heal. Don't be afraid to ask for help, and get the rest you need.
• Eat nutritious foods: Iron-rich foods like red meat, green vegetables, and fortified breakfast cereals help make red blood cells. Nutritious foods can help you heal.
• Drink water: Drink plenty of water after giving birth to prevent dehydration.
• Follow your doctor's instructions: Your doctor may prescribe medications or lifestyle changes to help you recover. Follow those instructions carefully.
• Keep an eye on the amount of bleeding: Wear a sanitary pad. Watch how long it takes for it to fill up. The bleeding should gradually decrease over a few weeks. If it doesn't, see your doctor.

Bleeding heavily can be a very traumatic experience. It is normal to take some time to recover emotionally from your childbirth experience. You may need support from your family, friends, doctors, or others. Talk about how you are feeling, and ask for help when you need it.

When should you see a doctor?

Most often, PPH happens after you give birth or while you're in the hospital. However, if you're bleeding heavily after you get home or if you develop any symptoms of PPH, see your doctor right away . If your doctor's office is closed or you can't reach them, go to the emergency room at your nearest hospital.

If you experience heavy bleeding after giving birth, see a doctor immediately. Other symptoms of PPH include dizziness, fainting, and difficulty breathing. PPH is a serious condition that requires immediate medical attention.

If you or a loved one has PPH, it's normal to feel shocked and scared by the experience. But remember, early detection and prompt treatment can prevent serious complications. That's why it's important to be open and honest with your doctor about your medical history. This will help you determine if you're at risk for PPH.

Final Take-Home Message

• PPH (Postpartum Hemorrhage) is a serious condition that requires immediate medical attention, characterized by excessive bleeding after childbirth.
• If you experience symptoms such as excessive bleeding, passing large blood clots, dizziness, fainting, or increased heart rate , seek medical advice immediately .
• The main cause of PPH is uterine atony, which is the inability of the uterus to contract properly. Other causes include injuries, retained placenta, and blood clotting problems.
• Although there are some risk factors, PPH can happen to anyone .
• If detected early and treated promptly, it can often be completely cured.
• The PPH experience can be emotionally draining. Don't hesitate to get the support you need.

Taking care of your health is very important, especially during times like these. You are not alone, ask for help.

` Postpartum hemorrhage, PPH, childbirth, bleeding, uterus, placenta, women's health