Postpartum hemorrhage (PPH) is a significantly life-threatening complication that can occur after both vaginal and caesarean births (Ricci & Kyle, 2009). Simpson and Creehan (2008) define PPH as the amount of blood loss after vaginal birth, usually more than 500mL, or after a caesarean birth, normally more than 1000mL. However, the definition is arbitrary, attributed to the fact that loss of blood during birth is intuitive and widely inaccurate (Ricci & Kyle, 2009). In line with this, studies have suggested that health care providers consistently underestimate actual blood loss, thus, an objective definition of PPH would be any amount of bleeding that exposes a mother in hemodynamic jeopardy (Ricci & Kyle, 2009). Currently, PPH is the leading cause of maternal mortality worldwide, and it is estimated that, over 150, 000 women, die of the complication annually (Ricci & Kyle, 2009). Causes of Postpartum Hemorrhage
Excessive bleeding can occur at any time between the separation of the placenta and its expulsion or removal, and in tandem to this, there are different facets that cause PPH (Simpson & Creehan, 2008). PPH can amount from uterine atony, failure of the uterus to contract and retract after birth (Ricci & Kyle, 2009). Uterine atony is the most common cause of PPH, accounting for 70% of cases (Sheiner, 2011), and it is usually delineated by a marked hypotonia of the uterus (Simpson & Creehan, 2008). In addition, uterine atony is likely to occur when the uterus is over distended, depicted through polyhydramnios, multiple gestations, and macrosomia (Simpson & Creehan, 2008). Other factors that induce uterine atony encompass; traumatic birth, halogenated anaesthesia, lengthened labour, induction or augmentation of labour, intraamniotic infection, tocolytics, and multiparity (Simpson & Creehan, 2008). Sheiner (2011) also affirms that trauma is a significant cause of PPH, and it is typically associated with vaginal or birth canal lacerations and uterine rupture. Vaginal delivery can amount to varying asperity of vaginal, perineum-region between the genital organs and anus-, and cervix lacerations (Sheiner, 2011). Similarly, lacerations secondary to birth trauma may occur more frequently with operative vaginal birth, through the aid of forceps or vacuum (Simpson & Creehan, 2008). The lesions can lead to a concealed retroperitoneal or suprafascial hematomas, which inevitably leads to significant but unnoticed blood loss (Sheiner, 2011). On the other hand, uterine rapture is also a form of birth trauma that can effectively amount to life-threatening PPH, as well, it is a rare obstetrical complication, with incidence of approximately 0.6 -0.7 % in cases of a trial of vaginal birth after caesarean section (Sheiner, 2011). Uterine rupture can become symptomatic during the postpartum period manifesting as abdominal tenderness and maternal hemodynamic collapse (Sheiner, 2011). Another cause of PPH is retained placenta, which is primarily associated with a mean duration of the third stage of labour (8-9 minutes), and Sheiner (2011) attests that longer intervals of the third stage of labour, poses as a great risk of PPH, with double the rate after ten minutes. Further, retained placental parts interpose and interfere with uterine contractions and may either cause early or late PPH (Sheiner, 2011). In conjunction to this, coagulation disorder is also a cause of PPH. It is a rare disorder that accounts only for one percent of cases (Sheiner, 2011). Other causes of PPH include; episiotomy, uterine inversion and hematomas of the vulva, which are also associated with muscle tones, tissues, stress and thrombosis (Ricci & Kyle, 2009).
Clinical Presentation and Risk Factors
PPH may be divided into two presentations; early PPH, which normally occurs before 24 hours, and late PPH, which usually takes place between 24 hours and six weeks (Ricci & Kyle, 2009). Moreover, symptoms of PPH vary according...
References: Ricci, S. S. & Kyle, T. (2009). Maternity and Pediatric Nursing. Philadelphia, PA: Wolters Kluwer Health/ Lippincott Williams & Wilkins.
Sheiner, K. E. (Ed.). (2011). Bleeding During Pregnancy: A Comprehensive Guide. New York, NY: Sringer Science + Business Media, LLC.
Simpson, R. K. & Creehan, A. P. (2008). Perinatal Nursing (3rd Ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
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