Introduction
After the delivery of a baby, some bleeding is normal, but when the bleeding becomes excessive or uncontrolled, it is called Postpartum Hemorrhage (PPH).
PPH is a serious obstetric emergency and one of the major causes of maternal death, especially in developing countries like India.
Definition
Postpartum Hemorrhage (PPH) is defined as:
“Excessive bleeding after the delivery of a baby — more than 500 ml after vaginal delivery or 1000 ml after cesarean section.”
If bleeding occurs within 24 hours of delivery, it is called Primary (Early) PPH.
If it occurs after 24 hours up to 6 weeks, it is called Secondary (Late) PPH.
Types of Postpartum Hemorrhage
| Type | Time of Occurrence | Description |
|---|---|---|
| Primary PPH | Within 24 hours of delivery | Most common; caused by uterine atony or trauma |
| Secondary PPH | After 24 hours to 6 weeks postpartum | Caused by infection or retained placental tissue |
Causes of PPH (The 4 T’s Rule)
| Cause | Description |
|---|---|
| Tone | Uterine atony (uterus fails to contract) – most common cause |
| Tissue | Retained placenta or membranes |
| Trauma | Vaginal, cervical, or perineal tears |
| Thrombin | Blood clotting disorders (coagulation defects) |
Signs and Symptoms
- Continuous vaginal bleeding
- Pallor, weakness, and restlessness
- Low blood pressure and rapid weak pulse
- Cold and clammy skin (signs of shock)
- Soft and boggy uterus on palpation
- Decreased urine output
Nursing Assessment
- Assess amount and type of bleeding
- Monitor vital signs (BP, pulse, respiration)
- Check uterine tone and contraction
- Observe for signs of shock
- Check bladder status (full bladder may prevent uterine contraction)
Nursing Management
1. Immediate Actions
- Call for medical assistance immediately
- Perform uterine massage to help contraction
- Administer oxytocic drugs like Oxytocin (Pitocin) or Methergine as prescribed
- Keep the mother lying flat with legs elevated
- Maintain airway and provide oxygen if required
2. Fluid and Blood Replacement
- Start IV fluids (Normal saline or Ringer’s lactate)
- Arrange for blood transfusion if necessary
3. Monitor and Record
- Record input and output
- Check vital signs every 15 minutes until stable
- Observe uterus and vaginal bleeding continuously
4. Emotional Support
- Reassure the mother and family
- Provide emotional support and rest
5. Prevention
- Active management of third stage of labour (use oxytocics)
- Early detection of risk factors
- Proper uterine massage after delivery
Complications
- Hypovolemic shock
- Anemia
- Acute renal failure
- Death (if not treated promptly)
Health Education
- Advise the mother to take rest after delivery
- Maintain personal hygiene
- Report immediately if heavy bleeding occurs
- Take iron-rich diet and medications regularly