We conclude our Pregnancy series with ‘Keeping New Mothers Safe – symptoms of Postpartum Haemorrhage’.

Postpartum haemorrhage (PPH) is excessive or severe vaginal blood loss a woman experiences during the 6 week period of having a baby.

The last two parts in the series have looked at how commonly abnormal post-pregnancy bleeding happens and how the condition could develop after pregnancy.

In this article, let’s explore the signs and symptoms of postpartum haemorrhage.

In other terms, how can we suspect when it is happening so we can intervene quickly?

Signs and Symptoms of Postpartum Haemorrhage

The following are signs to look out for after birth and may be an indication of postpartum haemorrhage :^[6],[8]

• Vaginal bleeding which is bright red, 4 days postpartum
• When vaginal bleeding happens with large blood clots (for example, bigger than an egg)
• Any bleeding that requires the use of more than one sanitary pad within an hour
• Feeling extremely weak and tired all the time
• Experiencing feelings of lightheadedness or dizziness
• Developing pain similar to menstrual cramps (or more severe) in your lower back or abdomen
• Pain or swelling around the vagina
• You may feel very cold, and develop clammy skin
• Feeling your heart racing, beating fast or in an irregular pattern (palpitations)

Conditions That Make PPH More Likely

Some conditions may increase the risk of postpartum haemorrhage.

They may exist i) before labour, ii) occur during labour or iii) afterwards.

PPH ….Before Labour

• Obesity
• Anaemia (reduced oxygen-carrying ability in the blood)
• Hypertension (High blood pressure)
• Being pregnant over the age of 40 years
• Death of the baby within the womb
• If you had PPH in a previous pregnancy
• Any conditions that cause very large growth in the womb
  • e.g. multiple pregnancies (i.e. more than one baby),
  • a baby weight of 4000 grams and more,
  • having a pregnancy with excess amniotic fluid
• Having been pregnant and delivered several times in the past.
• Conditions affecting the placenta like a low-lying placenta, placental abruption, etc.
• Having a tendency to bleeding disorders
• Using medications such as ‘blood thinners’ (anticoagulants)
• Tumours (benign growths) in or around the uterus

During Labour

• Prolonged labour (being in labour for greater than 12 hours)
• Placental retention
• Developing Vaginal/Cervical tears
• Delivery by Caesarean section
• A ‘burst’ womb (uterine rupture)

After Labour

• Weakness of the womb muscles which prevents them from tightening (contracting) after the placenta has been delivered.
  • This means that the norma contraction which should happen (and stop bleeding) fails to happen.
    • It is responsible for most cases of postpartum haemorrhage
• Infection of the womb

Preventing the Development of Postpartum Haemorrhage Symptoms

The good news is that postpartum haemorrhage can be prevented, and most mothers can be saved.

The first step to preventing postpartum haemorrhage is to register for antenatal care.

Doing so very early in your pregnancy and keeping regular antenatal appointments is important.

Antenatal care allows proper supervision of your pregnancy by qualified clinicians.

This allows you to discuss any doubts or concerns about your health.

Therefore, the right steps can be taken to reduce any pregnancy-related risks – including PPH.

Additionally, some of those conditions that can result in PPH (such as anaemia and hypertension), can be controlled.

This is because your blood pressure is checked at every antenatal care visit and routine blood tests are done at specific intervals.

Antenatal care would also help to prepare the expecting mother for labour and after birth.

Reducing Tragic Deaths from Preventable Causes Among New Mums.

Postpartum haemorrhage can result in the death of new mothers.

But it is preventable. Antenatal care can help identify those problems that cause PPH before, during and after birth.

This gives us a good chance to take the right preventive and treatment actions to be taken very early.^[5]

Knowing what signs and symptoms of postpartum haemorrhage to watch for plays an essential role.

Not only should health workers be aware, pregnant women can also learn what to be watch for – and to call for help urgently.

Additionally, it is important for women who have just delivered to observe proper hygiene.

Doing so prevents womb infections which can increase the likelihood of postpartum haemorrhage within 24 hours after birth.

Close observation particularly in the immediate 6-week period after birth as a woman recovers is important.

New mothers are advised to get enough rest and stay away from strenuous activities (including sexual intercourse) to allow ample time for healing.

This is especially the case if they experienced complications such as vaginal lacerations during labour.

We must do all that is possible to keep new mothers and pregnant women safe.

Have you any experience of PPH – yourself or a relative? What struck you most about how the condition developed?

Let us know in the comments section below.

More Reading:

• Preventing Mums bleeding after delivery – Part 1
• Keeping New Mums safe; bleeding after delivery – Pt 2
• These Eight Reasons Will Make You Drink More Water Everyday
• What YOU can do today to Cancer-Proof yourself.
• Myths tackled – What is a Vaginal Pessary?

 References
 
1. Postpartum hemorrhage: incidence, risk factors, and outcomes in a low-resource setting.  
2.Pregnancy, Acute Postpartum Hemorrhage.   
3. A 10 year autopsy-based study of maternal mortality in Lagos State University Teaching Hospital, Lagos, Nigeria.  
4.Reducing maternal deaths in a low resource setting in Nigeria.  
5.World Health Organization, 2018. Maternal Mortality.   
6.Postpartum Bleeding: What To Expect After Giving Birth.  
7.Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030

Editing By AskAwayHealth Team

Disclaimer

All AskAwayHealth articles are written by practising Medical Practitioners on a wide range of health care conditions to provide evidence-based guidance and to help promote quality health care. The advice in our material is not meant to replace the management of your specific condition by a qualified health care practitioner.
To discuss your condition, please contact a health practitioner or reach us directly