Overview
What the Bleeding Means
Postpartum haemorrhage (PPH) is excessive bleeding after birth that can become life threatening before the measured volume appears dramatic.
Postpartum haemorrhage (PPH) is excessive bleeding after birth that can become life-threatening before the measured volume appears dramatic. FIGO defines primary PPH as blood loss of at least 1000 mL, or any blood loss accompanied by signs or symptoms of hypovolaemia, within 24 hours of birth, regardless of whether birth was vaginal or by caesarean. Many Canadian teaching resources and institutional protocols still use the older convention of at least 500 mL after vaginal birth or at least 1000 mL after caesarean. These numbers should not delay treatment of an unstable patient. The mechanism is often failure of the uterus to contract. After the placenta separates, contraction compresses the open spiral arteries at the placental site. A relaxed, enlarged uterus leaves those vessels open, producing uterine atony—the commonest cause of PPH. The other principal causes are remembered as the four Ts: - Tone: a boggy or poorly contracted uterus. - Trauma: cervical, vaginal or perineal laceration, uterine rupture, haematoma or inversion. - Tissue: retained placenta or retained products of conception. - Thrombin: coagulation failure, including consumption of fibrinogen during severe...