Postpartum Hemorrhage (PPH)
Postpartum hemorrhage is defined as blood loss exceeding 500 mL following a vaginal birth or 1000 mL following a cesarean section within 24 hours. It remains a leading cause of maternal mortality worldwide.
The “4 Ts” of PPH
- Tone (Most common cause): Uterine atony; the uterus fails to contract after delivery.
- Trauma: Lacerations to the genital tract, uterine rupture, or inversion.
- Tissue: Retained placenta, membranes, or blood clots.
- Thrombin: Coagulopathy (e.g., pre-existing, or secondary to massive hemorrhage).
Management Strategy
| Approach | Action |
|---|---|
| Medical | Uterotonics (Oxytocin, Ergometrine, Carboprost, Misoprostol). |
| Mechanical | Uterine massage, bimanual compression, balloon tamponade (e.g., Bakri balloon). |
| Surgical | B-Lynch suture, uterine artery ligation, hysterectomy (last resort). |
High-Yield Exam Pearl:
- Prophylaxis: Active management of the third stage of labor (administration of prophylactic oxytocin) significantly reduces the incidence of PPH.
- Primary vs. Secondary: Primary PPH occurs within the first 24 hours; secondary PPH occurs between 24 hours and 12 weeks postpartum, often due to retained tissue or infection.