| Postpartum bleeding | |
|---|---|
| Other names | Postpartum hemorrhage |
 | |
| A non-pneumatic anti-shock garment (NASG) | |
| Specialty | Obstetrics |
| Symptoms | Significant blood loss after childbirth, increased heart rate, feeling faint upon standing, increased breath rate[1][2] |
| Causes | Poor contraction of the uterus, not all the placenta removed, tear of the uterus, poor blood clotting[2] |
| Risk factors | Anemia, Asian ethnicity, more than one baby, obesity, age older than 40 years[2] |
| Prevention | Oxytocin, misoprostol[2] |
| Treatment | Intravenous fluids, non-pneumatic anti-shock garment, blood transfusions, ergotamine, tranexamic acid[2][3] |
| Prognosis | 3% risk of death (developing world)[2] |
| Frequency | 8.7 million (global)[4] / 1.2% of births (developing world)[2] |
| Deaths | 83,100 (2015)[5] |
Postpartum bleeding or postpartum hemorrhage (PPH) is often defined as the loss of more than 500 ml or 1,000 ml of blood following childbirth.[2] Some have added the requirement that there also be signs or symptoms of low blood volume for the condition to exist.[6] Signs and symptoms may initially include: an increased heart rate, feeling faint upon standing, and an increased breathing rate.[1] As more blood is lost, the patient may feel cold, blood pressure may drop, and they may become restless or unconscious.[1] In severe cases circulatory collapse, disseminated intravascular coagulation and death can occur. The condition can occur up to twelve weeks following delivery in the secondary form.[7] The most common cause is poor contraction of the uterus following childbirth.[2] Not all of the placenta being delivered, a tear of the uterus, or poor blood clotting are other possible causes.[2] It occurs more commonly in those who already have a low amount of red blood, are Asian, have a larger fetus or more than one fetus, are obese or are older than 40 years of age.[2] It also occurs more commonly following caesarean sections, those in whom medications are used to start labor, those requiring the use of a vacuum or forceps, and those who have an episiotomy.[2][8]
Prevention involves decreasing known risk factors including procedures associated with the condition, if possible, and giving the medication oxytocin to stimulate the uterus to contract shortly after the baby is born.[2] Misoprostol may be used instead of oxytocin in resource-poor settings.[2] Treatments may include: intravenous fluids, blood transfusions, and the medication ergotamine to cause further uterine contraction.[2] Efforts to compress the uterus using the hands may be effective if other treatments do not work.[2] The aorta may also be compressed by pressing on the abdomen.[2] The World Health Organization has recommended the non-pneumatic anti-shock garment to help until other measures such as surgery can be carried out.[2] Tranexamic acid has also been shown to reduce the risk of death,[3] and has been recommended within three hours of delivery.[9]
In the developing world about 1.2% of deliveries are associated with PPH and when PPH occurred about 3% of women died.[2] It is responsible for 8% of maternal deaths during childbirth in developed regions and 20% of maternal deaths during childbirth in developing regions.[7] Globally it occurs about 8.7 million times and results in 44,000 to 86,000 deaths per year making it the leading cause of death during pregnancy.[4][2][10] About 0.4 women per 100,000 deliveries die from PPH in the United Kingdom while about 150 women per 100,000 deliveries die in sub-Saharan Africa.[2] Rates of death have decreased substantially since at least the late 1800s in the United Kingdom.[2]
- ^ a b c Lynch, Christopher B- (2006). A textbook of postpartum hemorrhage : a comprehensive guide to evaluation, management and surgical intervention. Duncow: Sapiens Publishing. pp. 14–15. ISBN 9780955228230. Archived from the original on 2016-08-15.
- ^ a b c d e f g h i j k l m n o p q r s t u v Weeks, A (January 2015). "The prevention and treatment of postpartum haemorrhage: what do we know, and where do we go to next?". BJOG: An International Journal of Obstetrics and Gynaecology. 122 (2): 202–10. doi:10.1111/1471-0528.13098. PMID 25289730. S2CID 32538078.
- ^ a b Shakur, Haleema; Roberts, Ian; Fawole, Bukola (April 2017). "Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial". The Lancet. 389 (10084): 2105–2116. doi:10.1016/S0140-6736(17)30638-4. PMC 5446563. PMID 28456509.
- ^ a b GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. (8 October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
- ^ GBD 2015 Mortality and Causes of Death Collaborators. (8 October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
- ^ Gibbs, Ronald S (2008). Danforth's obstetrics and gynecology (10th ed.). Philadelphia: Lippincott Williams & Wilkins. p. 453. ISBN 9780781769372. Archived from the original on 2016-06-05.
- ^ a b Bienstock, Jessica L.; Eke, Ahizechukwu C.; Hueppchen, Nancy A. (29 April 2021). "Postpartum Hemorrhage". New England Journal of Medicine. 384 (17): 1635–1645. doi:10.1056/NEJMra1513247. PMC 10181876. PMID 33913640.
- ^ Lockhart, E (2015). "Postpartum hemorrhage: a continuing challenge". Hematology. American Society of Hematology. Education Program. 2015 (1): 132–7. doi:10.1182/asheducation-2015.1.132. PMID 26637712.
- ^ World Health Organization (October 2017). "Updated WHO Recommendation on Tranexamic Acid for the Treatment of Postpartum Haemorrhage" (PDF). World Health Organization. Retrieved 2020-04-11.
- ^ GBD 2013 Mortality and Causes of Death Collaborators (17 December 2014). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 385 (9963): 117–71. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604. PMID 25530442.