Types, Causes, Symptoms and Complications of Postpartum Hemorrhage (PPH)

Definition of Postpartum Hemorrhage (PPH):

Any amount of bleeding from or into genital tract following birth of the baby up to the end of the puerperium which adversely affects the general condition of the patient evidence by rise in pulse rate and falling blood pressure is termed as Postpartum Hemorrhage.

Different Types of Postpartum Hemorrhage (PPH):

1. Primary PPH:

Excessive bleeding from or into the genital tract after birth within 24 hours is primary PPH. In the majority, hemorrhage occurs within 2 hours following delivery.

• 3rd stage Hemorrhage: Excessive bleeding before expulsion of placenta,
• True PPH: Bleeding after expulsion of placenta (majority cases).

2. Secondary PPH:

Excessive bleeding from or into the genital tract after 24 hours of delivery up to 6 weeks (the end of puerperium) is secondary PPH.

Causes of Postpartum Hemorrhage (PPH):

A. Causes of Primary PPH:

1. Uterine atony (80%):

Predisposing causes are-

• Grand multi-Para,
• Over distension due to cause eg. big baby, twin, hydramnios,
• Anemia,
• Malnutrition,
• APH,
• Prolonged labour,
• Precipitate labour,
• Anesthetic drug eg. Halothane,
• Retained placenta,
• Malformation uterus,
• Mismanagement 3rd stage,
• Constricted ring,
• Uterine fibroid.

2. Trauma (20%),

3. Combination of atonic and traumatic causes,

4. Blood coagulation disorders, acquired or congenital.

B. Causes of secondary hemorrhage (Hge):

1. Retained bits of placenta or membrane – commonest,
2. Infection,
3. Sub involution,
4. Secondary hemorrhage from caesarian section wound (uterus),
5. Choriocarcinoma,
6. Cervical carcinoma,
7. Regeneration of uterine fibroid,
8. Polyp.

Clinical Features of Postpartum Hemorrhage (PPH):

Symptoms of Postpartum Hemorrhage:

Bleeding per vagina within 24 hours of delivery of fetus. It is usually visible but rarely may it be concealed.

Signs of Postpartum Hemorrhage (PPH):

1. Signs of hemorrhage and shock.

2. Per abdominal examination –

• Uterus is soft and flaccid. Height at higher level.
• In traumatic hemorrhage – Uterus contracted.

3. Per vaginal examination:

• Bleeding either copious or slow oozing or intermittent gushes occurs.
• Placenta delivered, not delivered or partially delivered.
• Injury at the birth canal may present.

Complications of Postpartum Hemorrhage (PPH):

All the complications of postpartum hemorrhage have listed in the below:

• Bleeding may be very rapid,
• Pulmonary embolism,
• Puerperal anemia and morbidity,
• Puerperal sepsis,
• Fear for further pregnancies. Hemorrhage is terrifying for the mother.

More questions related to this article:

1. What do you mean by postpartum hemorrhage?
2. What is meant by PPH?
3. What are the different types of postpartum hemorrhage?
4. What are the causes of postpartum hemorrhage?
5. Mention the causes of primary postpartum hemorrhage.
6. Point out the complications of postpartum hemorrhage.
7. Describe the complications of postpartum hemorrhage.
8. What are clinical features of postpartum hemorrhage?
9. What are the major sign and symptoms of postpartum hemorrhage?

Maria Mona

Maria Khatun Mona is a Founder and Editor of Nursing Exercise Blog. She is a Nursing and Midwifery Expert. Currently she is working as a Registered Nurse at Evercare Hospital, Dhaka, Bangladesh. She has great passion in writing different articles on Nursing and Midwifery. Mail her at “[email protected]”