Postpartum Hemorrhage (PPH) is a significant and potentially life-threatening medical condition that occurs after childbirth. It is characterised by excessive loss of blood, typically defined as blood loss exceeding 500 millilitres for a vaginal delivery or 1000 millilitres for a cesarean section. PPH is a critical concern due to its capacity to lead to severe maternal morbidity and even mortality.

1. Postpartum Hemorrhage
Discover the definition, types, causes, symptoms, and treatment options for
postpartum hemorrhage, a serious condition that affects new mothers.
Memoona Arshad
10 Sem - Group 11 - ISM-IUK
Presented to: Uzakbaeva Manisa

2. Definition of Postpartum Hemorrhage
Postpartum Hemorrhage (PPH) is a
significant and potentially life-threatening
medical condition that occurs after childbirth.
It is characterised by excessive loss of
blood, typically defined as blood loss
exceeding 500 millilitres for a vaginal
delivery or 1000 millilitres for a cesarean
section. PPH is a critical concern due to its
capacity to lead to severe maternal
morbidity and even mortality.

3. Types of Postpartum Hemorrhage
Primary Postpartum Hemorrhage (PPH)
• This type occurs within the first 24 hours after childbirth.
• The most common cause of primary PPH is uterine atony, which is
when the uterus fails to contract properly after delivery.
• Other causes may include trauma, retained placental tissue, and blood
clotting disorders.
Secondary Postpartum Hemorrhage
• This type occurs between 24 hours and 6 weeks after childbirth.
• It is often related to issues such as retained placental tissue, infection,
or underlying uterine abnormalities that were not initially apparent after
delivery.

4. Causes and Pathogenesis of
Postpartum Hemorrhage (4
T's)
Background
• Failure of the Uterus to contract sufficiently during & after delivery of a boy.
• Myometrium doesn't respond to Oxytocin.
• Most common cause of Postpartum Hemorrhage (Obstetric Emergency)
Uterine Atony (Tonicity)
One of the most common causes
is when the uterus fails to
contract effectively after delivery.
The uterine muscles should
naturally contract to close off
blood vessels, but if they don't, it
can lead to uncontrolled bleeding.
Trauma
Physical injuries during childbirth
can result in excessive bleeding.
This may include tears in the
cervix or vaginal wall, often
associated with difficult deliveries
or the use of forceps.

5. Causes and Pathogenesis of
Postpartum Hemorrhage
(Contd..)
Retained Placental (Tissue)
Sometimes, fragments of the
placenta or membranes may
remain in the uterus after
childbirth. This can prevent the
uterus from contracting
properly, leading to persistent
bleeding.
Blood Clotting
Disorders (Thromtin)
Certain medical conditions, like
hemophilia or von Willebrand
disease, affect the blood's
ability to clot. In such cases,
the postpartum bleeding may
be prolonged and require
specialized treatment.

6. Signs and Symptoms of Postpartum
Hemorrhage
Excessive
Vaginal Bleeding
Heavy or profuse bleeding
from the vagina, often
soaking through one or more
pads in an hour
Rapid Heart Rate
An abnormally fast heart rate
(tachycardia) as the body
attempts to compensate for
blood loss.
Low Blood Pressure
A drop in blood pressure,
leading to symptoms such as
dizziness, lightheartedness,
or fainting.
Large Blood Clots
Passing large blood clots,
typically larger than a golf
ball.
Uncontrolled
Bleeding
Continued and uncontrolled
bleeding despite uterine
massage or other
interventions.
Pale or Cold Skin
The skin may become pale,
cool to the touch, or clammy
as a result of decreased
blood circulation.

7. Signs and Symptoms of Postpartum
Haemorrhage (Contd..)
Weakness
or Fatigue
Excessive bleeding
can lead to a
feeling of weakness
or extreme
tiredness.
Confusion
or Altered
Mental State
In severe cases, a
woman may become
confused or disoriented
due to decreased oxygen
and blood supply to the
brain.
Swelling
and Pain in
the Perineal
Area
Pain and swelling in the
perineum or vaginal area
can be indicative of
trauma-related bleeding.
Decreased
Urine
Output
A notable reduction
in urine production
may occur as the
body tries to
conserve fluid in
response to blood
loss.

8. Diagnosis of Postpartum Hemorrhage
1 Clinical Assessment
The healthcare provider evaluates
the mother's overall clinical
condition, including her medical
history, and assesses any visible
signs of excessive bleeding.
2
Vital Signs Monitoring
Vital signs like blood pressure and
heart rate are closely monitored for
changes, which can indicate
hemorrhage.
3 Uterine Examination
The provider checks the firmness of
the uterus to identify conditions like
uterine atony.
4
Blood Loss Estimation
An estimation of blood loss is made
by measuring soaked pads or using
other appropriate methods. 5 Blood Tests
Hemoglobin and hematocrit levels
are tested to assess the extent of
blood loss.
6
Ultrasound and Further Tests
In specific cases, ultrasound and
other diagnostic tests may be
employed to identify the cause and
extent of bleeding, such as retained
placental tissue or trauma.

9. Treatment of Postpartum Hemmorhage
Maneuvers
• uterine massage +/- bimanual compression
Medications
• Oxytocin (10-40 U in 1000 ml as continuous infusion) -TXA - (1g over 10 minutes)
• Cytotec (600-1000 mg rectally, oral, or sublingual)
• Carboprost (IM.25 mg, contraindicated in asthma) -Methylergonovine (IM.2 mg,
contraindicated in CAD, HTN, preeclampsia)
Surgical/Invasive including Bakri Balloon, vascular ligation, TAH