Normal Delivery But Abnormal Bleeding

हिन्दी

Normal delivery and the usual bleeding that follows…how does breastfeeding help? When does excessive bleeding require medical help? Have you had an episiotomy? There are a few things which every woman should know about post partum haemorrhage, an obstetric emergency.

Prolonged labor made Abha Sharma extremely tired. She and her family were ecstatic about the birth of a son, but everyone was concerned about the frail mother who seemed to be going through some abnormally high blood loss. Had something gone wrong during delivery? Would her body be able to cope? In the case of most women, a woman’s body produces the oxytocin hormone naturally, to cope with the blood loss after delivery. This production is triggered by breastfeeding, but sometimes the hormone may have to be administered in a synthetic form.  

Uma had a Caesarean for the delivery of her second child – while the first one was a normal delivery. Her labor was rapid and she had full-blown PPH or post-partum hemorrhage. This would mean medical treatment is required.

On the other hand, even though Persis Dumasia had both C-sections, she was unaware that a hemorrhage could lead to clotting problems which would further aggravate the bleeding.

What exactly is Post Partum Haemorrhage?

Classified as an obstetric emergency, it is more than the usual or normal bleeding after delivery. Women with a C-section would bleed more than those who have had vaginal deliveries. This normal bleeding occurs when the placenta while getting detached from the uterus leaves behind open blood vessels which bleed into the uterus. Only when this blood loss gets excessive, quantified as more than 500 ml, for normal delivery and 1500ml for C-section; it can be termed as Post Partum Haemorrhage.

PPH can also be defined in another way – when the blood loss is enough to cause hypovolemia and requires transfusion of blood products. It can be quantified as a 10% drop in the hematocrit.

When the hemorrhage occurs within 24 hours of delivery it is categorized as early, immediate or primary PPH. If the hemorrhage occurs within days or weeks after delivery, that type of PPH is grouped under delayed or secondary PPH.

Vandana Chakravarty, a first-time mom was prepared for everything thanks to the able guidance of Snigdha Mehta’s pre-natal class at a Western suburb. She could immediately sense that she was going through excessive bleeding, especially since she had fibroids, and immediately reported it to her doctor. When the gynecologist arrived, she gathered the families of all the women who had delivered, to keep them abreast of other risk factors.

Causes and risk factors pertaining to PPH

• A systemic blood clotting disorder, or any type of infection such as fibroids
• Obesity
• Having multiples
• Previous history of PPH
• Ruptured or inverted uterus
• Cervical lacerations
• Episiotomy or deep tears of the vagina
• Severe preeclampsia
• Placental abruption

While a systemic blood clotting could be inherited, it may also develop during pregnancy. This is where pre-natal check-ups assume even more significance, as the gynecologist can keep the mom-to-be ready for any such emergency, should it arise.

When Una’s husband, read up more about PPH, he realized that one in 5 women would undergo PPH, it was quite common and most hospitals are well equipped to deal with it.

Treatment

PPH is one of the causes of high mortality rates and hence needs to be treated on an urgent basis, just like in an emergency.

• One way is removing clotted blood from the uterus to help it to contract.
• Oxytocin may be delivered intravenously
• A catheter may be inserted to empty out the bladder as a full bladder makes it very difficult for the uterus to contract.
• A tiny balloon may be placed in the uterus to make blood vessels compress and encourage blood clotting.
• If bleeding still persists, pain medication will be given and the new mom will be wheeled into the operation room.
• In very rare cases, abdominal surgery or a hysterectomy may have to be performed to quell the hemorrhage.

After delivery, blood pressure and pulse rates are frequently monitored to check the condition of the mother and how she’s coping with the blood loss. Recovery depends on the reserves that a woman has and whether she is anemic. Blood tests are performed to check for anemia as well as to supervise whether blood clots are happening the normal, natural way.

Follow-ups & vital postnatal care

After delivery, every woman needs plenty of rest and nutritious food. Iron supplements may be prescribed. Much to the relief of Abha’s family, there was no cause for worry. They ensured that she stayed well hydrated with fluids and was given various preparations laced with ample ghee!