Curriculum · Gynecology / Women's Health / Infertility / Perinatal Care / Birth Spacing
Primary postpartum haemorrhage
What it is
Postpartum hemorrhage is a loss of more than 500 ml after normal vaginal delivery, or more than 1000 ml after cesarean section. Primary PPH occurs within 24 hrs of delivery and its cause is an atonic uterus. Secondary PPH occurs after 24 hrs and up to 6 weeks, from retained placental bits or from infection.
Causes and risk
The causes are held in four T's. Tone is the atonic uterus. Trauma is a genital tract injury or a uterine tear, and there the uterus is contracted. Tissue is retained placental bits, and there the uterus is not contracted. Thrombosis means coagulopathy. Uterine inversion is listed with them. The risk factors for an atonic uterus are a previous PPH, polyhydramnios, fetal macrosomia, grand-multiparity, uterine fibroids, labour that is prolonged or induced, placenta previa and abruption, CCB, and bacterial toxins from chorioamnionitis or endomyometritis. Grand multiparity also raises the risk of malpresentation, placenta previa and rupture. Trauma such as lacerations and episiotomies increases the risk of postpartum hemorrhage, so routine episiotomy should be avoided. PPH is itself one of the complications of placental abruption.