Postpartum hemorrhage (PPH) is defined as blood loss exceeding 500 ml after vaginal delivery within 24 hours. It is a leading cause of maternal mortality, especially in resource-poor settings. Risk factors include polyhydramnios, macrosomia, prolonged labor, and previous surgery. Management involves resuscitation, assessing uterine contraction, exploring the uterus, and administering oxytocics for atony or performing manual removal of placental tissue. Prevention strategies include active management of the third stage of labor with oxytocics immediately after delivery and risk assessment during antenatal care.

2. Definition
A blood loss in excess of 500ml after a vaginal
delivery, occurring in the first 24 hrs post-
partum

3. Background
 PPH is a leading cause of maternal mortality
in resource-poor settings
 Uterine blood flow (UBF) at term is 500-700
ml/min
 Approx. 85% of UBF goes to the placental
cotyledons

4. Aetiology
 Uterine atony - common
 Obstetric lacerations
 Retained placental tissue
 Inverted uterus
 Ruptured uterus
 Defective coagulation

5. Risk Factors
 Polyhydramnios, multiple gestation, macrosomia
 Prolonged labour, grandmultiparity
 Fibroid, placenta praevia
 Previous surgery
 Precipitous or instrumental delivery
 Pregnancy induced hypertension
 Bleeding diasthesis, liver disease

6. Management
 All available personnel should be mobilized.
Inform Obstetrician/anaeshetist.
 Resuscitate: iv access, O2 by mask, monitor
vital signs, catheterize
 assess uterine contraction; explore uterus &
LGT; expel & observe blood clots
 FBC, clotting profile, Group & Xmatch

7. Management contd…
 Atony – massage, compress, oxytocics
 Placental causes – remove manually or do a
gentle curretage (if not morbidly adherent)
 Obstetric trauma – repair lacerations, correct
inversion (under analgesia); identify rupture
 Reverse Coag. Defect – desmopressin,
replace factors…

8. Controlling bleeding
 Uterine exploration
 Bimanual compression &massage
 Abdominal aorta compression
 Curretage
 Oxytocics
 Operative management

9. Use of oxytocics
Useful in uterine atony
 Oxytocin – im 10units, follow iv infusion 20 U
in 1 L (max. 3L)
 Ergometrine – im/iv 0.5 mg bolus. Can repeat
after 15 min, then q4hrs (max 5 doses). Not used
in hypertensive or heart disease
 Prostaglandins

10. Prevention
 Risk assessment not reliable in predicting PPH
 Active management of the third stage of labour –
give oxytocic at the delivery of the anterior
shoulder
 Antenatal care – women with normal Hb levels are
more likely to tolerate blood loss
- Thank you

11. References
1. Managing complications in pregnancy and Childbirth. WHO;
http://www.who.int/reproductive-
health/inpac/Symptoms/Vaginal_bleeding_after_S25_S34.html
2. Prevention and Management of Postpartum Haemorrhage. SOGC.
http://sogc.medical.org/SOGCnetsogc_docs/common/guide/pdfs/ps88
.pdf