What is postpartum hemorrhage (PPH)?
Postpartum hemorrhage is defined as excessive blood loss quantified as 1,000 mL or
greater with signs of hypovolemia within 24 hours of birth (Postpartum Hemorrhage, 2017).
Signs of hypovolemia include cool, clammy skin, fatigue, pallor (pale skin), decreased level of
consciousness, and generalized weakness (Hypovolemic Shock: MedlinePlus Medical
Encyclopedia, 2024). Primary postpartum hemorrhage occurs within 24 hours of birth, while
secondary postpartum hemorrhage can occur up to 12 weeks after birth (Postpartum
Hemorrhage, 2017). Postpartum hemorrhage is one of the most common complications
following childbirth and can lead to further complications if not treated rapidly.
How does it occur?
Postpartum hemorrhage is caused by the 4 T’s: tone (uterine tone), trauma (uterine
trauma), tissue (retained placental tissue or clots), and thrombin (blood clotting deficiencies)
(Wormer et al., 2024; Postpartum Hemorrhage (PPH): Causes, Risks & Treatment, 2023).
Themost common cause of PPH is generally due to the lack of uterine contractions after childbirth.
This is essential because uterine contractions are responsible for expelling blood clots and
returning the uterus to its normal size. After birth, the uterus should begin to feel firm, instead of
boggy or soft.
Other causes may include blood loss during a cesarean section, delayed placental
delivery after birth of the child, lacerations or ruptures, and previously diagnosed clotting
disorders.
Signs and Symptoms of PPH
Signs and symptoms of PPH mirror hypovolemic shock. This may include feeling faint,
cool or clammy skin, sweating, a decreased level of consciousness, a drastic drop in blood
pressure, increased heart rate, and excessive and uncontrolled blood loss quantified as ≥ 1,000
mL of blood within 24 hours or up to 12 weeks after childbirth.
Treatment
Initial treatment of PPH generally includes a fundal massage and administration of
Pitocin (oxytocin). Massaging the fundus of the uterus helps to expel clots and to help promote
uterine contractions. Similarly, oxytocin is a naturally occurring hormone that plays a role in
promoting uterine contractions. This can be administered in its synthetic form as Pitocin to helpreduce hemorrhaging. The most important factor to consider when treating PPH is to determine
the cause and to treat the source of bleeding directly.
To account for the large amount of blood loss, providers may initiate blood transfusions
to help restore blood (Bienstock et al., 2021).
Severe Complications Associated with PPH
If left untreated, PPH can result in serious complications, such as death. Other
complications include infection, hypovolemic shock from immense blood loss, acute renal
(kidney) failure, hepatic (liver) failure, and excessive clotting, also known as disseminated
intravascular coagulation (DIC) (Bienstock et al., 2021).
Timely recognition of the signs and symptoms of PPH and its timely treatment offer
the best chance for a good outcome.
At the Law Offices of Judy Greenwood, PC our experienced medical malpractice
lawyers have familiarity with cases involving post-partum hemhorrage that caused significant
harm. If you or someone you know has experienced post-partum bleeding that resulted in
significant injury and have questions about your medical care, call our office for a FREE
CONSULTATION. Call 215-557-7500.
References
Bienstock, J. L., Eke, A. C., & Hueppchen, N. A. (2021). Postpartum Hemorrhage.
New England Journal of Medicine, 384(17), 1635–1645.
https://doi.org/10.1056/nejmra1513247
Hypovolemic shock: MedlinePlus Medical Encyclopedia. (2024). Medlineplus.gov.
https://medlineplus.gov/ency/article/000167.htm
Postpartum Hemorrhage. (2017).
Acog.org.https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/0/
postpartum-hemorrhage
Postpartum Hemorrhage (PPH): Causes, Risks & Treatment. (2023, August 24).
Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/22228-postpartum-
hemorrhage
Wormer, K. C., Jamil, R. T., & Bryant, S. B. (2024, July 19). Postpartum Hemorrhage. Nih.gov;
StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499988/
