Postpartum Haemorrhage (PPH): Recognising Signs & Why Immediate Action is Vital

The birth of a child is a time of immense joy and profound transition. As new parents, your world shifts to focus on this precious new life. However, it’s vitally important to remember that the period immediately following childbirth – the postpartum period – is also a critical time for the mother’s health and recovery. Whilst most women recover smoothly, being aware of potential complications is essential for ensuring safety. One such serious complication is Postpartum Haemorrhage (PPH).

My name is Dr. Vrushali Pillai, and as a Senior Consultant Obstetrician & Gynaecologist at Borneo Hospital, Thane, part of the Borneo group serving families across Thane, Nashik, Chhatrapati Sambhaji Nagar, and Raipur, maternal safety is our absolute priority. We believe knowledge empowers families. Understanding Postpartum Haemorrhage (PPH) – what it is, how to recognise the warning signs early, and why immediate medical action is crucial – can truly be life-saving. This article aims to provide this essential information in a clear, easy-to-understand manner.

Please note: This information is for educational purposes. If you ever suspect PPH, it is a medical emergency requiring immediate professional attention.

What Exactly is Postpartum Haemorrhage (PPH)?

Postpartum Haemorrhage (PPH) means experiencing excessive bleeding after giving birth. While some bleeding is normal after delivery, PPH refers to blood loss that is significantly more than usual and potentially dangerous. Medically, it’s often defined as losing more than 500ml of blood following a vaginal birth or more than 1000ml after a Caesarean section. However, any amount of bleeding that causes symptoms like dizziness, a rapid heart rate, or a drop in blood pressure is treated as PPH.

There are two main types based on timing:

• Primary PPH: Occurs within the first 24 hours after delivery. This is the most common type and usually happens while the mother is still under medical supervision in the hospital.
• Secondary PPH: This occurs later, anytime between 24 hours and up to 12 weeks after delivery. Awareness of this type is crucial after you go home.

PPH is considered an obstetric emergency because losing a large volume of blood quickly can lead to serious health consequences for the mother, including severe anaemia, shock (a critical drop in blood pressure affecting organ function), the need for blood transfusions, and in rare cases if not managed promptly, more severe outcomes. This underscores why rapid recognition and treatment are absolutely vital.

Understanding the Causes: Why Does PPH Happen?

After your baby is born and the placenta (afterbirth) is delivered, your uterus (womb) needs to contract down strongly. Imagine it clenching like a fist. These powerful contractions squeeze shut the large blood vessels that were supplying the placenta, effectively stopping significant bleeding. PPH occurs when this crucial process fails or when there is another source of bleeding. The main causes are often remembered by the “4 Ts”:

1. Tone (Uterine Atony): This is the most frequent cause (around 70-80% of cases). The uterus muscle fails to contract effectively after birth; it feels soft and ‘boggy’ instead of firm. This might happen if the uterus was overstretched (e.g., due to twins, a large baby, excess amniotic fluid) or simply became tired after a very long or rapid labour.
2. Trauma: Tears or lacerations sustained during birth can cause significant bleeding. These can occur in the cervix, vagina, perineum (area between vagina and anus), or even, rarely, the uterus itself (uterine rupture). Proper identification and repair are essential.
3. Tissue: If small pieces of the placenta or foetal membranes remain inside the uterus after delivery, they can prevent the uterus from contracting down fully, leading to persistent bleeding.
4. Thrombin: Problems with blood clotting ability (coagulopathy). This is less common but can occur due to pre-existing bleeding disorders or certain pregnancy complications like severe pre-eclampsia, HELLP syndrome, or placental abruption that affect clotting factors.

Identifying the specific cause is task for the medical team, as it guides the appropriate management.

Knowing the Risk Factors (Being Prepared, Not Alarmed)

It is critical to understand that Postpartum Haemorrhage (PPH) can happen to any woman after childbirth, even those with no apparent risk factors. Therefore, preparedness and vigilance are essential for every delivery. However, certain factors do increase the statistical likelihood, helping your medical team at Borneo Hospital to be extra alert and prepared:

• A history of PPH in a previous pregnancy.
• Carrying multiples (twins, triplets, etc.).
• Having had many previous births.
• A prolonged or very rapid labour.
• Labour induction or augmentation (using medication to start or speed up labour).
• Assisted vaginal delivery (using forceps or vacuum).
• Caesarean section delivery.
• A large baby (macrosomia).
• Excess amniotic fluid (polyhydramnios).
• Placental abnormalities (placenta praevia, placental abruption, suspected placenta accreta).
• Significant anaemia during pregnancy (a common concern in India).
• Certain medical conditions like bleeding disorders.
• Uterine fibroids.
• Infection during labour (chorioamnionitis).

Knowing these risk factors allows our team to take extra precautions, such as ensuring blood is readily available if needed, but it doesn’t mean PPH is inevitable.

RECOGNISING THE WARNING SIGNS: WHEN TO ACT IMMEDIATELY

This is the most crucial section for all new parents and their families. Early recognition saves lives. Be aware of these signs, both in hospital and especially after returning home:

Signs of Primary PPH (Usually Within 24 Hours of Birth, Often in Hospital):

• EXCESSIVE Vaginal Bleeding: This is the main sign. Look for:
  • Soaking through more than one large maternity pad in an hour.
  • Passing large blood clots (bigger than a golf ball or small lemon).
  • Continuous heavy flow of bright red blood that doesn’t seem to slow down or stop. (Normal postpartum bleeding, or lochia, starts heavy like a period but should gradually lessen over time, changing colour. PPH bleeding is noticeably heavier or persists).
• Signs of Shock / Significant Blood Loss (Alert Medical Staff IMMEDIATELY):
  • Feeling suddenly very dizzy, lightheaded, weak, or faint, especially when trying to sit or stand up.
  • Heart racing, pounding, or feeling weak and rapid (palpitations).
  • Skin feeling cold, clammy, or looking pale.
  • Feeling confused, disoriented, unusually anxious, or agitated.
  • Shortness of breath.

Signs of Secondary PPH (At Home – Days to Weeks After Birth):

• Bleeding Suddenly Gets Heavy Again: Your lochia should be decreasing and lightening in colour (red to pink/brown to whitish). If it suddenly becomes bright red and heavy again, soaking through pads quickly (e.g., hourly), seek immediate medical help.
• Passing Large Clots after the first day or two.
• Foul-Smelling Lochia: A bad or offensive odour can signal a uterine infection (endometritis), which sometimes triggers secondary PPH.
• Persistent Lower Abdominal Pain or Tenderness, especially if you also develop a fever.
• Fever (over 100.4°F or 38°C) or Shaking Chills.
• Ongoing Symptoms of Significant Blood Loss/Anaemia: Still feeling very dizzy when standing, extreme fatigue far beyond normal new-mum tiredness, feeling breathless easily, having heart palpitations.

WHAT TO DO – IMMEDIATE ACTION REQUIRED:

• If you are IN THE HOSPITAL: Alert your nurse or doctor IMMEDIATELY. Use the call bell. Do not minimise your symptoms.
• If you are AT HOME: Treat any episode of very heavy bleeding or symptoms like severe dizziness/faintness/racing heart as a MEDICAL EMERGENCY.
  • Call for immediate emergency medical help (consider an ambulance if bleeding is very heavy or you feel very unwell) OR have someone take you directly to the nearest hospital Emergency Department (such as at Borneo Hospital) WITHOUT ANY DELAY.
  • Do NOT wait. Do not think it might get better on its own. Time is absolutely critical in managing Postpartum Haemorrhage (PPH) effectively.

Hospital Management of PPH: Our Preparedness at Borneo Hospital

Please be reassured that managing PPH is a standard part of obstetric emergency training and preparedness in well-equipped hospitals. At all Borneo Hospital branches, we have established protocols and skilled teams ready 24/7. When PPH occurs, action is swift and coordinated:

1. Rapid Response: An emergency team, including obstetricians, anaesthetists, senior nurses, and support staff, is mobilised immediately.
2. Quick Assessment: We simultaneously assess your vital signs (BP, pulse, oxygen levels), estimate blood loss, and work to identify the cause (checking uterine tone, examining for tears, ensuring placenta is complete).
3. Immediate Actions: This usually involves:
   • Starting intravenous (IV) lines immediately to administer fluids rapidly and give medications.
   • Vigorous uterine massage through the abdomen to stimulate contractions.
   • Administering strong medications (uterotonics like Oxytocin/Syntocinon, Misoprostol, etc.) via IV or injection to force the uterus to contract firmly.
   • Ensuring the bladder is empty (a full bladder hinders uterine contraction).
4. Addressing the Cause: If tears are identified, they are promptly repaired (may require going to the operating theatre). If retained tissue is suspected, a procedure to remove it is performed. Blood tests might be sent to check clotting factors.
5. Blood Transfusion: If blood loss is significant, blood and blood products are readily available from our blood bank services and administered urgently.
6. Advanced Measures: If needed, further interventions like inserting a special intrauterine balloon (e.g., Bakri balloon) or surgical procedures are available. These are less commonly required but are part of our comprehensive emergency preparedness.

Our team approach ensures rapid, effective management focused on stopping the bleeding and ensuring the mother’s stability and safety.

Preventing PPH: What Helps Reduce the Risk?

While not all cases can be predicted or prevented, certain measures significantly lower the risk:

• Active Management of the Third Stage of Labour (AMTSL): This evidence-based practice is standard care at Borneo Hospital. It involves giving an oxytocic injection right after the baby’s birth, facilitating placental delivery, and immediate uterine massage. This drastically reduces PPH risk due to uterine atony.
• Good Antenatal Care: Identifying and treating severe anaemia during pregnancy is crucial. Discussing any risk factors beforehand allows our delivery team to be extra prepared.
• Skilled Delivery Care: Experienced management of labour and delivery by qualified obstetricians and midwives.

Recovery After Experiencing PPH

Recovering from a Postpartum Haemorrhage (PPH) requires time and care:

• Physical Recovery: You will likely feel more tired and weaker than expected due to the blood loss. Rest is absolutely essential. Focus on eating nutritious, iron-rich foods (dals, leafy greens, lean meats etc.). Your doctor will prescribe iron supplements – taking these diligently is very important to rebuild your haemoglobin levels.
• Emotional Impact: Experiencing a PPH can be frightening or even traumatic. It’s okay to feel shaken or anxious afterwards. Talk about your experience with your partner, trusted family, or your doctor. If feelings of distress persist, seeking counselling can be very beneficial.
• Follow-Up: Attending your postnatal check-ups is important for monitoring your recovery fully.

Postpartum Haemorrhage (PPH) is a serious potential complication following childbirth, but it is crucial to remember that it is usually very effectively managed with prompt recognition and expert medical care. The most important message for all new parents and families is awareness of the warning signs – particularly heavy, uncontrolled bleeding or feeling faint/dizzy – and the absolute need for immediate medical action if these occur.

Do not hesitate or delay in seeking help if you have any concerns about bleeding after delivery, whether in the hospital or after returning home. Hospitals like Borneo Hospital are well-prepared with trained teams and established protocols to handle such emergencies safely. Your awareness and quick response, combined with our medical readiness, are key to ensuring a safe outcome for every mother.