Abstract
Postpartum haemorrhage (PPH) is a major cause of maternal deaths in developing as well as developed countries. The Present article is to have an update on whys, hows of PPH and if PPH occurs the prevention of disability and death. Primary PPH, (within 24 hrs of birth) can be minor or major, further divided into moderate, severe. Once diagnosed by seeing excessive bleeding, case needs to be evaluated for the cause which could be uterine atony or injury to reproductive tract, retained placental pieces or coagulation problems. Visual evaluation underestimates blood loss. Risk factors are past PPH, fetal macrosomia, multiple births, placenta previa, placental abruption, prolonged labour, episiotomy or delay in expulsion of placenta. If placental separation and expulsion is expedited through medication and manualstimulation, risk of PPH can be reduced. Oxytocin for prevention continues to be the drug of choice with less side effects and efficacy similar to ergometrine, prostaglandins. Misoprostol, oral, stable at room temperature is being promoted. Any cut on perineum needs to be avoided. Correction of anemia before delivery is essential. Cornerstone of treatment is restoration of blood volume. If uterus is not well contracted, mechanical, pharmacological measures are instituted. All injuries need timely repair. Timely uterine packing or sutures stop bleeding and step wise devasculcusation preserves fertility. Pneumatic compression devices reduce mortality at all levels of health care. Hysterectomy is definitive therapy, needs to be done timely especially in placenta accreta, uterine rupture. Because of bleeding there is risk of reduced blood supply to anterior pituitary which can affect milk secretion and breastfeeding. Similarly supply to heart, and kidney can get affected and blood components might get depleted. Depression can occur. It is essential to continue research to know best modality of prevention of PPH and if it occurs aggressive therapy to prevent disability and death.
Keywords: Postpartum haemorrhage, prevention, risk factors, sequale, therapy.
Graphical Abstract
35