Postpartum Haemorrhage (PPH)
A Complete Clinical & Midwifery Guide for Safe Maternal Care
Overview
Postpartum haemorrhage (PPH) is a life-threatening obstetric emergency characterised by excessive bleeding after childbirth. It requires immediate recognition and intervention to prevent maternal collapse, shock, and death. Despite advances in obstetric care, it remains one of the leading causes of maternal mortality worldwide.
Definition
PPH is defined as blood loss ≥500 mL following vaginal delivery or ≥1000 mL following caesarean section. Clinically, any amount of bleeding that causes haemodynamic instability is considered significant.
Classification
Primary PPH
Occurs within 24 hours of delivery. It is usually sudden and severe.
Secondary PPH
Occurs from 24 hours to 6 weeks postpartum, often due to infection or retained products.
Causes – The 4 Ts
Tone
Uterine atony – failure of the uterus to contract effectively.Tissue
Retained placental fragments preventing uterine contraction.Trauma
Cervical, vaginal, or uterine injury during delivery.Thrombin
Blood clotting disorders affecting haemostasis.Risk Factors
- Previous history of PPH
- Prolonged labour
- Multiple pregnancy
- Macrosomia
- Polyhydramnios
- Induced or augmented labour
- High parity
- Anaemia in pregnancy
Clinical Features
- Excessive vaginal bleeding
- Soft, boggy uterus
- Tachycardia
- Hypotension
- Pallor and sweating
- Dizziness or collapse
Management
Management is immediate and life-saving. It involves simultaneous resuscitation and identification of cause.
- Call for emergency help
- Establish IV access and fluids
- Uterine massage
- Administer oxytocin and other uterotonics
- Control bleeding source
- Blood transfusion if necessary
Nursing & Midwifery Role
- Early identification of risk factors
- Active management of third stage of labour
- Close postpartum monitoring
- Accurate blood loss estimation
- Administration of medications
- Emotional support to mother and family
Prevention
Prevention is key in reducing maternal deaths from PPH. This includes skilled birth attendance, routine use of uterotonics, antenatal screening, and proper labour management.